Median effective dose of esmolol for maintaining cardiovascular stability in elderly and non-elderly hypertensive patients during tracheal extubation

Abstract

Objective To study the optimal dose of esmolol for maintaining cardiovascular stability in patients with hypertension during tracheal extubation. Methods In post-anestheisa care unit, hypertensive patients after general anesthesia meeting the extubation criteria were included. Patients were divided into 2 groups according the age: group Ⅰ (>65 years old for the elderly hypertensive, 21 cases), and group Ⅱ (≤ 65 years old for the non-elderly hypertensive, 22 cases). All the patients received esmolol bolus before sputum suction and tube extraction, and the tracheal extubation were extubated 2 minutes after esmolol bolus. The systolic blood pressure, diastolic blood pressure and heart rate were was recorded before tracheal extubation, 2 min after esmolol bolus, at the time of sputum suction extubation, 1 min after tracheal extubation, 3 min after tracheal extubation and 5 min after tracheal extubation. Esmolol dose was determined by the up and down method. Initial dose was 0.5 mg/kg, in accordance with the arithmetic dose (0.2 mg/kg) increasing or decreasing progressively. In negative results (the systolic blood pressure at extubation or 5 min after extubation ≥ 20% of the base, or the systolic blood pressure at sputum suction extubation >180 mmHg, 1 mmHg = 0.133 kPa) esmolol dose increased progressively, and in positive results (the systolic blood pressure at extubation or 5 min after extubation <20% of the base) esmolol dose decreased progressively. When the crosspoint (from positive to negative result) reached 6, the study was terminated. Results The median effective doses of esmolol for maintaining cardiovascular stability in group Ⅰ and group Ⅱ were (0.6±0.1) and (0.8±0.1) mg/kg. Conclusions Esmolol can maintain cardiovascular stability in patients with hypertension during tracheal extubation. Median effective dose decreases in older hypertensive patients. Key words: Hypertension; Aged; Esmolol; Tracheal extubation; Median effective dose