The effects of esmolol, esmolol and nicardipine or remifentanil on mean blood pressure, heart rate and recovery in gynecologic laparoscopic surgery

Abstract

Background:The purpose of this study was to compare the effects of esmolol, esmolol and nicardipine or remifentanil on MBP, HR and recovery in gynecologic laparoscopic surgery.Methods: Eighty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to four groups: group C (control group, n = 20); group E (esmolol group, n = 20) received esmolol 1 mg/kg, followed by 5 μg/kg/min; group EN (esmolol ＋ nicardipine group, n = 20) received esmolol 1 mg/kg and nicardipine 15 μg/kg, followed by an esmolol infusion 5 μg/kg/min; and group R (remifentanil group, n = 20) received remifentanil 1 μg/kg, followed by 0.05 μg/kg/min. The MBP and HR were measured at preinduction, after induction, at 1, 3, 5 min after intubation, before and after insufflation of CO2 and during surgical procedures. Recovery profiles and postoperative side effects were assessed.Results: The change of MBP after intubation was significantly decreased in group EN. The change of HR after intubation and during surgical procedure were significantly decreased in group E and group R. Recovery profiles were significantly faster in all study groups compared with group C.Conclusions: The use of esmolol in combination with nicardipine was effective in preventing the increase of MBP after intubation, whereas esmolol or remifentanil had attenuated the acute change of HR to noxious stimuli. Also the use of esmolol, nicardipine or remifentanil as an adjuvant to sevoflurane-N2O anesthesia in gynecologic laparoscopic surgery had facilitated the recovery.

The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis

“…[1214181920] The mean difference in emergence time between esmolol and placebo was 1.60 min (95% CI: −3.37–0.07, P = 0.07, I 2 = 89.9%); heterogeneity was noted to be high [Figure 4]. …”

“…Five studies reported on the use of rescue analgesics in the PACU. [ 9 11 12 13 14 ] Intravenous fentanyl was used as the rescue analgesic in four studies and intravenous infusion of tramadol along with intramuscular diclofenac was administered in one study. [ 13 ] Overall, esmolol reduced the requirement for rescue opioid by 69% [OR: 0.31, 95% CI: 0.16–0.80, P = 0.0001, I 2 = 0.0%, Figure 2 ].…”

“…Dichotomous data on PONV could be extracted from nine studies. [ 8 9 10 11 12 13 14 15 17 ] Pooled results showed that there was a 61% reduction in the incidence of PONV in patients who received esmolol compared with placebo (OR: 0.39, 95% CI: 0.20–0.75; P = 0.005, I 2 = 60.7%), however heterogeneity was high [ Figure 4 ]. A single antiemetic was administered prophylactically in four studies (three at the end and one at induction)[ 9 11 15 17 ] and dual antiemetics were administered in two studies (one at the end and one as a premedication).…”

“…Five studies reported the emergence time, and most of them were based on spontaneous eye opening, ability to follow simple commands, and orientation to person and place. [ 12 14 18 19 20 ] The mean difference in emergence time between esmolol and placebo was 1.60 min (95% CI: −3.37–0.07, P = 0.07, I 2 = 89.9%); heterogeneity was noted to be high [ Figure 4 ].…”

“…[ 4 5 ] When used as an adjunct, it has been shown to improve the postoperative recovery by reducing postoperative pain intensity and intraoperative anesthetic and opioid requirements and preventing opioid-induced hyperalgesia. [ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ]…”