Esmolol reduces anesthetic requirements thereby facilitating early extubation; a prospective controlled study in patients undergoing intracranial surgery

Abstract

BackgroundAdequate cerebral perfusion pressure with quick and smooth emergence from anesthesia is a major concern of the neuroanesthesiologist. Anesthesia techniques that minimize anesthetic requirements and their effects may be beneficial. Esmolol, a short acting hyperselective β-adrenergic blocker is effective in blunting adrenergic response to several perioperative stimuli and so it might interfere in the effect of the anesthetic drugs on the brain. This study was designed to investigate the effect of esmolol on the consumption of propofol and sevoflurane in patients undergoing craniotomy.MethodForty-two patients that underwent craniotomy for aneurysm clipping or tumour dissection were randomly divided in two groups (four subgroups). Anesthesia was induced with propofol, fentanyl and a single dose of cis-atracurium, followed by continuous infusion of remifentanil and either propofol or sevoflurane. Patients in the esmolol group received 500 mcg/kg of esmolol bolus 10 min before induction of anesthesia, followed by additional 200 mcg/kg/min of esmolol. Monitoring of the depth of anesthesia was also performed using the Bispectral Index-BIS and cardiac output. The inspired concentration of sevoflurane and the infusion rate of propofol were adjusted in order to maintain a BIS value between 40–50. Intraoperative emergence was detected by the elevation of BIS value, HR or MAP.ResultsThe initial and the intraoperative doses of propofol and sevoflurane were 18–50 mcg/kg/min and 0.2–0.5 MAC respectively in the esmolol group, whereas in the control group they where 100–150 mcg/kg/ and 0.9–2.0 MAC respectively (p = 0.000 for both groups). All procedures were anesthesiologically uneventful with no episodes of intraoperative emerge.ConclusionsEsmolol is effective not only in attenuating intraoperative hemodynamic changes related to sympathetic overdrive but also in minimizing significant propofol and sevoflurane requirements without compromising the hemodynamic status.ClinicalTrials.gov Identifier: NCT02455440. Registered 26 May 2015.

Comparative study of the Ambu® AuraOnce™ laryngeal mask and endotracheal intubation in anesthesia airway management during neurosurgery

“…Esmolol combined with propofol or sevoflurane can inhibit the intubation reaction and reduce the amount of propofol or sevoflurane administered, which is conducive to smooth and rapid recovery after surgery. 23 However, there is still a risk of bradycardia; about 30% of patients may have transient bradycardia 24 or the depth of anesthesia may be affected, resulting in shallow anesthesia. The above-mentioned adverse conditions did not occur in this study, but this may be because of the small sample size or the good heart function in the patients.…”

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

“…Beta-agonists increase wakefulness and excitation by activating the reticular activating system in the brain, [30] in turn reducing cortical arousal, which is how esmolol reduces agitation. [30,31] Several studies found that esmolol reduced the need for analgesics and sedatives, but most researchers have reported that esmolol is more effective when combined with other drugs than when administered as monotherapy. [10,22,32,33] For this reason, we combined esmolol with lidocaine, which relieves sore throat.…”

“…Strabismus surgery in children is known to cause minimal pain, [25,34] so we attempted to determine whether injection of lidocaine can reduce agitation by attenuating stimulation of the airway. And also, we predicted that because esmolol not only maintains hemodynamic stability but also suppresses wakefulness, [30] using the two agents in combination would achieve a greater reduction in agitation. Therefore, we compared an EL group with a lidocaine group, and found that only the patients in the EL group had a statistically significant reduction in agitation.…”

Akromegalili olguda gelişen postoperatif ciddi hipertansiyon

“…Hayvan modellerinde, GH seviyesi ile ilişkili olarak distal tübüller içerisine sodyum retansiyonu olduğu gösterilmiştir7. Ayrıca akromegalide aldosteron sentezi ve aldosterona duyarlılığın arttığı, yüksek IGF seviyelerinin aynı zamanda arterioler kalınlaşmaya da neden olduğu bilinmektedir [8][9] . Colao ve arkadaşları akromegalik olgularda ana karotid arterde intima-media kalınlığının (IMT) aynı yaşdaki gönüllülerden daha fazla olduğunu (1.04 mm -0.8 mm) vurgulamışlardır 9 .…”