Bolus Dose Of Esmolol Research Articles

Potential Attenuating Effect of Single Bolus Dose of Esmolol on Cardiovascular Stress Response in Elective Neurosurgical Cases

A prospective, double blind and randomized study was conducted in the Department of Anesthesiology of Dhaka Medical College Hospital, Dhaka, Bangladesh, between January 2013 and January 2014, to assess the efficacy of single bolus dose of esmolol (1.5mg/kg) to attenuate the cardiovascular stress response in elective neurosurgical cases. A total of 100 elective neurosurgical patients were enrolled in this study. Patients were randomly allocated equally into two groups: group A and group B, having 50 patients in each group. Patients of group A received intravenous esmolol (1.5mg/kg), 3 minutes before induction, while patients of group B received intravenous 10 ml of normal saline 3 minutes before induction. Parameters like heart rate, systolic and diastolic blood pressure were recorded before induction and every alternative minute for 10 minutes after endotracheal intubation. There were no differences in baseline demography of the patients (P>0.05). However, our data showed that in group A, there were significant reductions in heart rates immediately after induction, 1 minute, 3 minutes and 5 minutes after endotracheal intubation (P<0.01), as well as significant reductions in systolic and diastolic blood pressure after 1 minute, 3 minutes and 5 minutes of endotracheal intubation (P<0.01) respectively, in comparison to group B. Besides, reductions in rate pressure product were observed immediately after induction and 1 minute, 3 minutes and 5 minutes after endotracheal intubation respectively in group A, as compared to group B (P<0.01). In summary, a single bolus dose of esmolol (1.5mg/kg) effectively attenuates the cardiovascular stress response during and after laryngoscopy and endotracheal intubation in elective neurosurgical cases.
 CBMJ 2022 July: vol. 11 no. 02 P: 96-101

Efficacy of a single dose of esmolol to prevent extubation-related complications during emergence from anesthesia: a randomized, double-blind, placebo-controlled trial

BackgroundFew trials have examined the efficacy of esmolol to attenuate hemodynamic and respiratory responses during extubation. However, the most appropriate dose of esmolol and an optimal protocol for administering this beta-blocker are uncertain. MethodsNinety patients ASA physical status I, II, and III (aged 18–60 years) scheduled to procedures with general anesthesia and tracheal extubation were selected. Patients were randomized into esmolol and placebo group to evaluate the efficacy and safety of a single bolus dose of esmolol (2 mg.kg-1) on cardiorespiratory responses during the peri-extubation period. The primary outcome was the rate of tachycardia during extubation. ResultsThe rate of tachycardia was significantly lower in esmolol-treated patients compared to placebo-treated patients (2.2% vs. 48.9%, relative risk (RR): 0.04, 95% confidence interval (95% CI) = 0.01 to 0.32, p = 0.002). The rate of hypertension was also significantly lower in the esmolol group (4.4% vs. 31.1%, RR: 0.14, 95% CI 0.03 to 0.6, p = 0.004). Esmolol-treated patients were associated with higher extubation quality compared to patients who received placebo (p < 0.001), with an approximately two-fold increase in the rate of patients without cough (91.1%) in the esmolol group compared to the placebo group (46.7%). The rate of bucking was approximately 5-fold lower in the esmolol group (8.9% vs. 44.5%, respectively, RR: 0.20 (95% CI, 0.1 to 0.5, p = 0.002, with an NNT of 2.8). ConclusionA single bolus dose of esmolol is an effective and safe therapeutic strategy to attenuate cardiorespiratory responses during the peri-extubation period.

Efficacy of a Bolus Dose of Esmolol and Bolus Dose of Lignocaine for Attenuating the Pressor Response to Laryngoscopy and Endotracheal Intubation in General Anesthesia: A Comparative Study.

Context:Laryngoscopy and endotracheal intubation result in an increase in heart rate and blood pressure; they evoke life-threatening complications. The esmolol is short-acting cardioselective beta-blocker and brings advantages to the perioperative management of tachycardia and hypertension.Aims:The aim of this study was to compare the efficacy of a bolus dose of esmolol and bolus dose of lignocaine for attenuation of the pressor response to laryngoscopy and intubation.Settings and Design:Sixty patients of both sex, aged 20–50 years, belonging to the American Society of Anesthesiologists physical Status I and II randomly allocated into two groups (n = 30).Materials and Methods:The study drugs diluted in 10-ml normal saline. Group I received esmolol 1.5 mg/kg and Group II received lignocaine 1.5 mg/kg 2 min before inducing the patients with thiopentone 5 mg/kg and suxamethonium 1.5 mg/kg. The heart rate, systolic blood pressure, and diastolic blood pressure were measured at basal, during intubation, and 1, 2, 3, and 5 min after intubation, and based on these values, the mean arterial pressure (MAP) and rate pressure product (RPP) was calculated.Statistical Analysis Used:The Student's t-test and data were represented by mean standard deviation and graphs.Results:The mean pulse rate, mean of MAP, and mean of RPP at intubation and at 1, 2, 3, and 5 min after intubation in lignocaine group showed a significant rise in these values but in esmolol group it remained nearer to or less than baseline values.Conclusions:Esmolol 1.5 mg/kg is effective in attenuating the pressor response in comparison with lignocaine 1.5 mg/kg during laryngoscopy and intubation.

Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol

BackgroundThe field of cochlear implantation has been expanding rapidly and it has been hailed as one of the greatest advances in otology. The technique of anesthesia plays a crucial role in success of cochlear implant surgery as the anesthesiologist has to produce conditions which facilitate surgery by inducing bloodless operative field.Study objectiveTo determine the efficacy of dexmedetomidine versus esmolol usage as an adjunct to induce controlled hypotension in children undergoing cochlear implant surgery.DesignClinical trial study.SettingOperating room in a university hospital.Patients70 children aged 2–4 years scheduled for cochlear implant surgery under general anesthesia. Patients were randomly allocated according to drugs used into two equal groups (35 patients in each group). Interventions: Group (D): The patients in this group received a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by continuous infusion 0.2–0.5 ug/kg/h after induction of anesthesia but before surgery. Group (E): The patients in this group received a bolus dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion 100–300 ug/kg/min after induction of anesthesia but before surgery.MeasurementsHeart rate, Mean Arterial blood Pressure, Quality of surgical field, operative time, adverse events.Main resultsThe quality of surgical field was comparable between both groups in all times of measurements. The time to first analgesic request was statistically significant longer in group (D) than in group (E) and the total tramadol consumption was statistically significant less in group (D) than in group (E).ConclusionsIn our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

Effect of intravenous bolus esmolol on changes in heart rate during laryngoscopy and endotracheal intubation under general anesthesia in patients with mitral stenosis posted for closed mitral commissurotomy

Background: Maintenance of an optimal heart rate during laryngoscopy and endotracheal intubation is a key factor in the management of patients with mitral stenosis undergoing surgery under general anesthesia to minimize mortality. Esmolol is a rapid-onset and short-acting selective β1-blocker. Objective: To compare the effect of narcotic induction with and without intravenous bolus dose of esmolol on the changes in heart rate in response to laryngoscopy and endotracheal intubation in patients with mitral stenosis posted for closed mitral commissurotomy. Materials and Methods: Twenty patients of either sex, of age between 18 and 40 years with mitral stenosis posted for closed mitral commissurotomy, and without overt heart failure, other significant valvular disease, significant cerebrovascular disease, bronchial asthma, anticipated difficult airway, in rhythm other than sinus, heart block more than first degree, and already receiving a β-blocker or antihypertensive were allocated randomly to receive either normal saline (Group A, control group) or esmolol (Group B, study group) along with narcotic induction. Result: The median heart rate in Group B patients was significantly lower just before laryngoscopy, 1 min postintubation, and 2 min postintubation time points in comparison to Group A (Mann–Whitney U test). A serial change in the median heart rate was found to be statistically significant p < 0.05 (Friedman’s analysis of variance) in Group A and nonsignificant in Group B. Conclusion: Here, esmolol was found to be beneficial to obtund the heart rate response during intubation, especially in patients with mitral stenosis without any untoward responses.

Effects of intravenous and oral β-blockade in persistent asthmatics controlled on inhaled corticosteroids

ObjectiveDespite their benefits in the treatment of cardiovascular disease, β-blockers are seldom used to treat asthmatics. We assessed the safety and tolerability of acute dosing with esmolol and propranolol in...

A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation.

Objective:To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation.Methods:Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C (control) receiving 10 ml normal saline, group E (esmolol) receiving bolus dose of esmolol 2 mg/kg and group F (fentanyl) receiving bolus dose of fentanyl 2 µg/kg intravenously slowly. Study drug was injected 3 min before induction of anesthesia. Heart rate, systemic arterial pressure and ECG were recorded as baseline and after administration of study drug at intubation and 15 min thereafter.Results:Reading of heart rate, blood pressure and rate pressure product were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was highly significant. Also the rate pressure product at the time of intubation was minimal and was statistically significant rate 15 min thereafter in group E.Conclusion:Esmolol 2 mg/kg as a bolus done proved to be effective in attenuating rises in heart rate following laryngoscopy and intubation while the rise in blood pressure was suppressed but not abolished by bolus dose of esmolol.

Efficacy of esmolol administration at different time intervals in attenuating hemodynamic response to tracheal intubation

Laryngoscopy and endotracheal intubation are known to cause increase in both arterial blood pressure and heart rate. Several strategies have been evolved to blunt the haemodynamic response to tracheal intubation but each method has its own advantages and disadvantages. Esmolol, a cardio selective Beta-1 blocking drug, can alleviate some of these problems. Esmolol, when administered parenterally, exhibits rapid onset and a short duration of action due to its rapid clearance by red blood cell esterases. Hence we conducted the present study to evaluate the efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive- tachycardiac response to laryngoscopy and tracheal intubation. The randomized double blind prospective study was conducted in 60 patients, in the age group of 20-40 years, of both sexes, belonging to American Society of Anaesthesiologists (ASA) physical status class I or II and scheduled for elective surgery requiring endotracheal intubation and general anaesthesia. The efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive - tachycardiac response to laryngoscopy and tracheal intubation was evaluated. Patients in group I (n = 20) received bolus administration of injection esmolol 1.5 mg/kg intravenously (iv) 90 seconds before intubation; in group II (n = 20) three minutes before intubation and in group III (n = 20) six minutes before intubation. There was no clinical and statistically significant variation in heart rate in group I and II at different time intervals of the study period but in group III heart rate increased significantly one minute after tracheal intubation. (P < 0.05) One minute after intubation, the increase in systolic, diastolic and mean blood pressure and rate pressure product was statistically significant in group I (P < 0.01) and group III. (P < 0.05) However, in group II increase in systolic blood pressure and rate pressure product was statistically not significant. (P > 0.05) To conclude, single intravenous bolus dose of esmolol (1.5 mg/kg) is safe and more effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation when administered three minutes prior to intubation.

Treatment of Persistent Tachycardia with Dexmedetomidine During Off-Pump Cardiac Surgery

Treatment of Persistent Tachycardia with Dexmedetomidine During Off-Pump Cardiac Surgery

Low-dose esmolol bolus reduces seizure duration during electroconvulsive therapy: a double-blind, placebo-controlled study

We have measured the effect of a bolus dose of esmolol 80 mg i.v. on heart rate, and systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures during electroconvulsive therapy (ECT). We also assessed seizure duration using both the cuff method and two-lead EEG. We studied 20 patients in a double-blind, placebo-controlled, within-patient blocked randomized study. No patient was receiving psychotherapeutic drugs or had cardiovascular disease. Esmolol significantly reduced heart rate, SAP and MAP before the stimulus, and also significantly reduced the increases in these variables during the convulsion, compared with placebo. However, seizure duration was also significantly reduced, possibly making ECT less effective. The reduction in seizure duration was 5.83 s when monitored clinically and 9.9 s when measured by the EEG. Because of the reduction in seizure duration, routine administration of esmolol is not advisable because it may interfere with the efficacy of ECT, but administration of esmolol during ECT could be useful to reduce tachycardia and hypertension in high-risk patients.

Effect of pethidine and esmolol on the cardiovascular changes occurring during upper gastrointestinal endoscopy

The cardiovascular effects of patients undergoing upper GI endoscopy when sedated with midazolam and pethidine, or midazolam and esmolol have been compared. A significant rise in heart rate ( P < 0.006), systolic blood pressure ( P < 0.001) and rate pressure product (systolic blood pressure × heart rate) ( P < 0.001) occurred in both the patients receiving midazolam alone and those receiving pethidine in addition to midazolam. There were no significant differences in the peak rises in heart rate, blood pressure and, thus, rate pressure product between these two groups of patients. Those patients receiving a bolus dose of esmolol just prior to oesophagoscopy demonstrated a significantly smaller rate pressure response to oesophageal intubation than those in the first two groups.

The effects of a single bolus dose of esmolol on haemodynamic responses to laryngoscopy and tracheal intubation

The effects of a single bolus dose of esmolol on haemodynamic responses to laryngoscopy and tracheal intubation

Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation

Study Objective: To define the ability of esmolol and alfentanil to control the hemodynamic changes associated with extubation and emergence. Design: Randomized, double-blind, placebo-controlled study. Setting: General surgery operating rooms at a university hospital. Patients: Forty-two ASA physical status I and II patients without history of cardiac or pulmonary disease undergoing surgery not involving the cranium or thorax. Interventions: Patients were given either a bolus dose of normal saline followed by an infusion of normal saline, a bolus dose of alfentanil 5 μg/kg followed by an infusion of normal saline, or a bolus dose of esmolol 500 μg/kg followed by an infusion of esmolol 300 μg/kg/min. Measurements and Main Results: Emergence and extubation resulted in significant increases in heart rate (HR) and blood pressure (BP) in the placebo group. Alfentanil controlled the responses to emergence but prolonged the time to extubation ( p < 0.05). Esmolol significantly controlled the responses to emergence and extubation ( p < 0.05). Conclusions: Emergence and extubation after inhalation general anesthesia result in significant increases in BP and HR in healthy patients. An esmolol bolus dose and subsequent infusion significantly attenuated these responses. A small bolus dose of alfentanil minimized the responses to emergence but prolonged the time to extubation and was no longer protective at that point.

Esmolol prevents and suppresses arrhythmias during halothane anaesthesia in dogs.

The antiarrhythmic effect of esmolol, a selective beta 1 adrenoreceptor blocker, was evaluated in the presence of epinephrine induced arrhythmias in dogs (n = 6). The arrhythmogenic dose of epinephrine (ADE) during 1.2 MAC halothane in dogs was increased from 3.23 +/- 0.25 (mean +/- SD) to 30.90 +/- 3.56 micrograms.kg-1.min-1 (P less than 0.001) by the prior administration of esmolol 0.5 microgram.kg-1 bolus followed by an infusion at the rate of 150 micrograms.kg-1.min-1. Higher esmolol infusion doses of 200 micrograms.kg-1.min-1 further increased ADE to 99.0 +/- 2.92 micrograms.kg-1.min-1 (P less than 0.001). After discontinuation of esmolol and during continued halothane anaesthesia, ventricular tachycardia was induced by increasing the infusion rate of the 100 micrograms.ml-1 solution of epinephrine. In all dogs ventricular tachycardia was restored to sinus rhythm by a bolus dose of esmolol (1 microgram.kg-1). We conclude that esmolol pretreatment increases the ADE during halothane anaesthesia in dogs. Our data suggest that esmolol may be useful as an antiarrhythmic agent in the management of epinephrine-related ventricular arrhythmias during anaesthesia in man.

Bolus doses of esmolol for the prevention of postintubation hypertension and tachycardia

This study was designed to determine the safety and efficacy of 100-mg and 200-mg bolus doses of esmolol in the prevention of intubation-associated hypertension, tachycardia, ST depression, and dysrhythmias. Forty-five patients undergoing noncardiac surgery were randomly allocated to receive either placebo, esmolol, 100 mg, or esmolol, 200 mg, intravenously, 90 seconds prior to intubation. Both doses of esmolol decreased the mean maximum increase in heart rate and rate-pressure product by approximately 36% [ P < 0.01 y placebo), and attenuated these increases over the first 90 seconds postintubation. No effect on blood pressure was observed. Ventricular dysrhythmias occurred in 7 of 15 patients following placebo versus 4 of 30 patients receiving esmolol [ P < 0.05). No difference in any variable was detected between the two esmolol groups at any time. The incidence of hypotension and bradycardia was no greater following esmolol than after placebo, nor was esmolol associated with cardiac conduction disturbances or wheezing. It was concluded that bolus doses of esmolol safely attenuate the hemodynamic response to intubation and decrease the incidence of ventricular dysrhythmias.

Bolus Doses of Esmolol for the Prevention of Perioperative Hypertension and Tachycardia

The effectiveness of esmolol, an ultra short-acting cardioselective beta blocker, in the prevention and treatment of post-intubation haemodynamic perturbations, was investigated. Forty-eight ASA physical status I and II patients undergoing hysterectomy were randomly assigned to receive a single intravenous bolus of placebo, esmolol 100 mg, or esmolol 200 mg in a double-blind fashion. This was administered over 15 sec, and immediately followed by thiopentone 3-5 mg.kg-1, succinylcholine 1.5 mg.kg-1, and tracheal intubation 90 sec later. The heart rate following induction of anaesthesia was lower in the esmolol 200 mg group (P less than 0.01); following intubation, the increase in heart rate in the placebo group was greater than in the esmolol groups (P less than 0.05). The systolic blood pressure post-induction was lower in the esmolol 200 mg group (P less than 0.05); following intubation, however, no significant differences were seen among groups in systolic, diastolic, or mean blood pressures. Following tracheal intubation, the incidence of ventricular arrhythmias was lower in the esmolol groups (P less than 0.05). In summary, esmolol in 100 mg and 200 mg doses was effective in mitigating the haemodynamic response following tracheal intubation.

A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit

The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients, from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). The groups were similar in demographic characteristics and with regard to preoperative blood pressure (BP) and heart rate (HR). Anesthetic management was standardized for all patients. Fsmolol 100 mg (1.4 ± 0.3 mglkg) and 200 mg (2.6 ± 0.7 mglkg) significantly (p < 0.05) blunted the maximum increases in HR and BP following intubation. The average maximum HR increase in the placebo group was 40% as opposed to 16% in the esmolol 100 mg group and 14% in the esmolol 200 mg group. Both esmolol groups blunted the tachycardic response over a 4-minute postintubation time period. The average maximum BP increase was 47% in the placebo group versus 22% and 19% in. the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.

Bolus doses of esmolol for the prevention of perioperative hyper-tension and tachycardia

The effectiveness of esmolol, an ultra short-acting cardioselective beta blocker, in the prevention and treatment of post-intubation haemodynamic perturbations, was investigated. Forty-eight ASA physical status I and II patients undergoing hysterectomy were randomly assigned to receive a single intravenous bolus of placebo, esmolol 100 mg, or esmolol 200 mg in a double-blind fashion. This was administered over 15 sec, and immediately followed by thiopentone 3-5 mg.kg-1, succinylcholine 1.5 mg.kg-1, and tracheal intubation 90 sec later. The heart rate following induction of anaesthesia was lower in the esmolol 200 mg group (P less than 0.01); following intubation, the increase in heart rate in the placebo group was greater than in the esmolol groups (P less than 0.05). The systolic blood pressure post-induction was lower in the esmolol 200 mg group (P less than 0.05); following intubation, however, no significant differences were seen among groups in systolic, diastolic, or mean blood pressures. Following tracheal intubation, the incidence of ventricular arrhythmias was lower in the esmolol groups (P less than 0.05). In summary, esmolol in 100 mg and 200 mg doses was effective in mitigating the haemodynamic response following tracheal intubation.

A bolus dose of esmolol attenuates tachycardia and hypertension after tracheal intubation

Forty-five patients of ASA physical status I and II undergoing a variety of non-cardiac surgical procedures were studied to determine the effect of bolus administration of esmolol, a new short-acting beta blocking drug, on heart rate and blood pressure responses to induction of anaesthesia and tracheal intubation. Subjects were allocated randomly to receive placebo, 100 mg or 200 mg of esmolol IV as part of an anaesthetic induction technique. The differences in heart rate between the placebo group and both the 100 mg and 200 mg groups were significant prior to intubation (95 +/- 7.9, 82 +/- 9.7, 80 +/- 7.3 beats per min respectively), and also at 0.5 min and 1.5 min following intubation for the 200 mg group. In the 200 mg group there was a significant decrease, compared with placebo, in systolic blood pressure at 0.5 min (144 +/- 32.1 vs 165 +/- 18.7 mmHg) and 1.5 min (154 +/- 25.0 vs 170 +/- 19.5 mmHg) after intubation. In this study, adequate haemodynamic control was obtained following administration of 200 mg of esmolol.

Effects of bolus injection of esmolol in healthy, exercising subjects.

Esmolol is an investigational ultra-short-acting beta-adrenergic blocker that has potential application in many clinical cardiology settings. The purpose of this study was to investigate the effect of a bolus dose of esmolol on heart rate, blood pressure, and PR interval in healthy, exercising male subjects. We gave a single esmolol bolus over 30 seconds to 13 men who exercised to a predetermined target heart rate. Each subject performed the exercise protocol twice, receiving a different dose between 10 and 300 mg each time. An additional eight subjects received two esmolol boluses 5 minutes apart while performing the same exercise protocol. Esmolol doses of 180 mg or greater caused a 13% to 18% decrease in heart rate, an 11% to 18% decrease in blood pressure, and a 13% to 22% prolongation of the PR interval. The median time to peak esmolol effect was 1 minute for heart rate, 2 minutes for blood pressure, and 4 minutes for PR interval. The median time required to recover 50%, 75%, and 90% of the decrement in heart rate was 8, 10, and 13 minutes, respectively. The rapid onset and disappearance of esmolol effects may make it an appealing drug in acute care settings.