Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine

Abstract

Esmolol, an ultra-short-acting cardioselective betaadrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubationEsmolol is a cardioselective, beta-adrenergic blocking agent with a short duration of action because it is metabolized by a blood esterase,l The short duration of action permits rapid titration by intravenous infusion to a desired level of beta blockade. Likewise, cessation of esmolol infusion rapidly terminates the beta blockade.Numerous studies have reported hypertension and tachycardia associated with laryngoscopy and tracheal intubation that may be detrimental. 2-s Two recent studies utilized esmolol to block haemodynamic response after intubation in man following induction of anaesthesia with ketamine 6 or diazepare, N20 (50 per cent) and pancuronium. 7 The latter study 7 was conducted in patients scheduled for elective myocardial revascularization to determine the dosage that might safely and effectively reduce cardiovascular responses to intubation. Gold et al. 6 found that peak heart rates and systolic pressures following intubation after ketamine induction were significantly attenuated by esmolol. Likewise, Menkhaus et al. 7 observed significant reductions in heart rate, mean arterial pressure and CAN" ANAESTH SOC I 1986 / 33:5 / pp556-62

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

“…23,26,29,30,33,35,38,39,48 Heart rate achieved was not significant for any of the efficacy outcomes apart from non-fatal myocardial infarction-trials that achieved heart rate of 75 beats per min or less reported a lower reduction in risk than did the other group (tables 2 and 3).…”

“…High-bias risk trials Coleman 42 Lai 35 Liu 36 Magnusson 36 POBBLE 3 Poldermans 32 Stone 38 Urban 39 Zaugg 33 Liu 48 33 trials included 12 306 patients having non-cardiac surgery, 6311 (51%) patients randomly assigned to the β-blocker group, and 5995 (49%) to the control group. The β blocker used, dose given, timing of administration, and the duration of administration varied in the trials (table 1).…”

“…High-bias-risk trials Burn 41 Coleman 42 Jakobsen 46 Jakobsen 45 Liu 48 Liu 36 Mackenzie 49 Magnusson 37 Stone on the outcomes of cardiovascular mortality and heart failure (figures 2 and 3). A test for interaction showed significant effects of trial quality on all-cause mortality, cardiovascular mortality, and non-fatal myocardial infarction (figures 2 and 3).…”

“…Five trials enrolled high surgical-risk patients (emergency surgery, vascular surgery), 3,5,27,32,40 five enrolled intermediate-risk or high surgical-risk patients, 4,6,28,30,38 22 enrolled intermediate surgical-risk patients (intrathoracic, intraperitoneal, carotid endarterectomy, head and neck, orthopedic, or prostate surgery), [22][23][24][25][26]31,[33][34][35][36][37]39,[41][42][43][44][45][46][47][48][49][50] and one enrolled low surgical-risk patients. 29 A sensitivity analysis on the basis of surgical risk categories showed a 63% decreased risk of all-cause mortality and a 44% decreased risk of non-fatal myocardial infarction in trials with high surgical risk (tables 2 and 3); this finding was driven largely by the trial by Poldermans and colleagues.…”

Acute peri‐operative beta blockade in intermediate‐risk patients

“…We excluded nine studies which reported only major cardiovascular complications within 30 days of surgery [1,2,[21][22][23][24][25][26][27] and a further nine studies which did not present data on perioperative myocardial ischaemia [28][29][30][31][32][33][34][35][36].…”