Comparative Effects of Esmolol and Labetalol to Attenuate Hyperdynamic States After Electroconvulsive Therapy

Abstract

We studied 18 patients (age range, 53-90 yr) with at least one cardiovascular risk factor who were treated with electroconvulsive therapy (ECT) and compared effects of five pretreatments: no drug; esmolol, 1.3 or 4.4 mg/kg; or labetalol, 0.13 or 0.44 mg/kg. Each patient received all five treatments, during a series of five ECT sessions. Pretreatment was administered as a bolus within 10 s of induction or anesthesia. Doses of methohexital and succinylcholine were constant for the series of treatments and the assignment to no drug or to drug and dose was determined by randomized block design. Measurements of systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were recorded during the awake state and 1, 3, 5, and 10 min after the seizure. The deviation of ST segments from baseline was measured by an electrocardiogram (ECG) monitor equipped with ST-segment analysis software. The results (mean +/- SEM) show that without pretreatment, there were significant (P < 0.05) peak increases in SBP and HR (55 +/- 5 mm Hg and 37 +/- 6 bpm, respectively), recorded 1 min after the seizure. Comparable reductions (by approximately 50%) in these peak values were achieved after esmolol (1.3 mg/kg) or labetalol (0.13 mg/kg), and cardiovascular responses were nearly eliminated after the same drugs in doses of 4.4 and 0.44 mg/kg, respectively. The deviation of ST-segment values from baseline in any lead was not measurably influenced by either antihypertensive drug. SBP values were lower after labetalol 10 min after the seizure, but not after esmolol. Asystolic time after the seizure was not significantly longer with either drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography

“…It has a metabolism via rapid hydrolysis by red blood cell esterases, which is not dependent on renal or hepatic function [15]. Bolus doses of esmolol have been used to prevent tachycardia and hypertension perioperatively, and just before laryngoscopy and tracheal intubation procedures, as well as electroconvulsive therapy [16][17][18][19]. The prompt onset and offset of esmolol effects make it an appealing drug when short duration of heart rate and blood pressure control is desired.…”

Electroconvulsive therapy in the medically Ill

“…The most extensively studied beta-blockers are esmolol and labetalol. Esmolol (a short acting beta1-blocker) in the dose of 1 to 1.3 mg/kg and labetalol (a mixed alpha-and beta-blocker) in the dose of 0.1 to 0.2 mg/kg have been effective in the reducing the sympathetic cardiovascular response [19].…”

Effects of antihypertensive medication on left ventricular function during electroconvulsive therapy: study with transthoracic echocardiography

“…Recent guidelines have recommended the use of the ultra-short-acting b-blocker, esmolol, and the a-/b-blocker, labetalol, as antihypertensive medications for patients with cardiovascular coexisting diseases who are undergoing ECT [2,3]. Castelli et al [12] also reported that esmolol was relatively effective for treatment of ECT-induced hemodynamic changes despite persistent hemodynamic changes at 10 minutes after the seizure. In contrast, O'Connor et al [13] reported that one mg/kg of esmolol prevented abrupt changes in HR but not the abrupt change in systemic hemodynamics after ECT.…”

“…However, the conflicting data between studies may result from differences in the b-blocker dose. For example, Castelli et al [12] showed that low doses of labetalol (0.13 mg/kg) and esmolol (1.3 mg/kg) produced a 50% reduction in the peak increase in SBP, whereas high doses of labetalol (0.44 mg/kg) and esmolol (4.4 mg/kg) produced a near complete elimination of the increases in BP.…”