Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

Efe, Esra Mercanooglu; Bilgin, Basak Atabey; Alanoğlu, Zekeriyya; Akbaba, Murat; Denker, Çiğdem

doi:10.1016/j.bjane.2013.07.003

Cited by 17 publications

(20 citation statements)

References 26 publications

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“…With an elimination half-life of Ͻ10 min due to metabolism by red blood cell esterases and low lipid solubility, it is often administered as a bolus injection before transient stimulation such as laryngoscopy, cranial pinning, and electroconvulsive therapy (5,58). Indeed, comparative effectiveness studies in anesthetized patients have demonstrated that bolus injections of 20 -200 mg of esmolol attenuate HR responses to laryngoscopy and endotracheal intubation (13,14,29,33,41,43). Esmolol can also be administered as a continuous infusion to treat intraoperative tachycardia due to airway or surgical stimulation (10,16,18,31,61), as part of the hemodynamic management during resection of pheochromocytomas (40,62), to control HR during acute coronary syndromes (3) and thyrotoxicosis (8,12), and to aid in the diagnosis of supraventricular tachycardia (34).…”

Section: New and Noteworthymentioning

confidence: 99%

Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

Müller

Ahmad

Pelaez

et al. 2017

Journal of Applied Physiology

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Despite its widespread clinical use, the β-adrenergic receptor antagonist esmolol hydrochloride is not commonly used in human physiology research, and the effective dose of esmolol (compared with the nonselective β-blocker propranolol) is unclear. In four separate studies we used cycle ergometry exercise and infusions of isoproterenol and epinephrine to test the heart rate (HR)-lowering effect of esmolol compared with propranolol and saline in healthy humans. In , both esmolol (ΔHR 57 ± 6 beats/min) and propranolol (ΔHR 56 ± 7 beats/min) attenuated exercise tachycardia compared with saline (ΔHR 88 ± 17 beats/min). In, we found that the HR response to exercise was similar at 5 min (ΔHR 57 ± 9 beats/min) and 60 min (ΔHR 55 ± 9 beats/min) after initiation of the esmolol maintenance infusion. In , we confirmed that the HR-lowering effect of esmolol disappeared 45 min after termination of the maintenance infusion. In, changes in femoral blood flow and hematological parameters in response to epinephrine infusion were not different between esmolol and saline infusion, indicating that our esmolol infusion paradigm does not block β-receptors. Collectively, our data indicate that infusion of ~160 mg of esmolol (range 110-200 mg in the 5 min before exercise) acutely and selectively blocks β-receptors in healthy humans. Additionally, β-receptors remain blocked 60 min later if a maintenance infusion of ~0.2 mg·kg total body mass·min- continues. The current data lay the foundation for future studies to evaluate β- vs. β-receptor control of the circulation in humans. We used cycle ergometry exercise and infusions of isoproterenol and epinephrine to test the heart rate-lowering effect of esmolol compared with propranolol and saline in healthy humans. Collectively, our data indicate that infusion of ~160 mg of esmolol (range 110-200 mg in the 5 min before exercise) acutely and selectively blocks β1-adrenergic receptors. These infusion parameters can be used in future experiments to evaluate β1- vs. β2-receptor control of the circulation in humans.

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Section: New and Noteworthymentioning

confidence: 99%

Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

Müller

Ahmad

Pelaez

et al. 2017

Journal of Applied Physiology

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“…Similar result was seen in the Srivastava VK and Reddy SV et al 12,13 Similar result about dexmedetomidine to control HR and blood pressure after laryngoscopy observed in Lee JH et al, Bajwa SS et al and Efe EM et al study. [14][15][16] Keniya VM et al study observed that bradycardia occurred in two patients in dexmedetomidine group intraoperatively. 17 Decrease in HR was observed in our study in permissible limit but none of our patients required treatment with atropine.…”

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confidence: 96%

A comparative study of efficacy of intravenous dexmedetomidine and intravenous esmolol for attenuation of stress response during laryngoscopy and endotracheal intubation

Gupta

Vyas

2016

Int J Basic Clin Pharmacol

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INTRODUCTIONLaryngoscopy and tracheal intubation are noxious stimuli that evoke transient but marked sympathetic response manifesting as an increase in the heart rate, blood pressure, intraocular and intracranial pressure. These changes are seen maximum immediately after intubation and last for 5 to 10 minutes.1 Topical or intravenous (I.V.) lidocaine, opioids, inhaled anesthetics, vasodilators, calcium channel blockers or adrenergic blockers have been used successfully for decreasing the hemodynamic response to laryngoscopy. [2][3][4][5][6][7] Esmolol is a water soluble, rapid onset, ultra-short-acting, selective β adrenergic receptor antagonist with proven efficacy to provide hemodynamic stability during laryngoscopy and tracheal intubation.2 It has a half-life of nine minutes.Dexmedetomidine is an imidazole derivative and selective alpha α2 adrenergic receptor agonist. 8 α2-agonists produce hyperpolarization of noradrenergic neurons and suppression of neuronal firing in the locus ceruleus which leads to decreased systemic noradrenaline release resulting in attenuation of sympathoadrenal responses and hemodynamic stability during laryngoscopy and tracheal intubation. We conducted this study to compare the efficacy of esmolol and dexmedetomidine for attenuation of the ABSTRACT Background: The present study compares the effects of I.V. dexmedetomidine and I.V. esmolol on hemodynamic response occurring due to laryngoscopy and endotracheal intubation in elective general surgery. Methods: A total of 60 patients aged 18-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective surgical procedures were included in this study. Patients were randomly allocated by chit method into two equal groups of 30 each, comprising of group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 10 ml I.V. over 10min and group esmolol (group E) 1 mg/kg diluted with 0.9% saline to 10 ml I.V. given just before induction. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, after 5 min of infusion, after induction and at 1, 3, 5 and 10 min after endotracheal intubation. Results: In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, where as in group E, there was a statistically significant increase in blood pressure and heart rate after intubation at 1, 3, 5 and 10 min. Conclusions: Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective surgical patients.

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“…Efe et al . [ 19 ] compared between bolus of esmolol, infusion of esmolol and control and found esmolol infusion was more effective than esmolol bolus on controlling HR and BP during both intubation and sternotomy. Marashi et al .…”

Section: Discussionmentioning

confidence: 99%

Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial

Kamal

Agarwal

Singariya

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery. Material and Methods: Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 μg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 μg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and P < 0.05 was considered significant. Results: The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) ( P <0.001). Conclusion: Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.

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Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

Abstract: This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery.

Cited by 17 publications

References 26 publications

Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

A comparative study of efficacy of intravenous dexmedetomidine and intravenous esmolol for attenuation of stress response during laryngoscopy and endotracheal intubation

Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial

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