Comparison of two esmolol bolus doses on the haemodynamic response and seizure duration during electro-convulsive therapy

Abstract

Twelve ASA physical status I-III patients were enrolled in a double-blind, prospective, randomized, three-way, withinpatient Electroconvulsive therapy (ECT) may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia, t'2 The haemodynamic effects of ECT could place the patient with coronary or cerebrovascular disease at risk of myocardial ischaemia/ infarction or stroke. 3-5 Esmolol hydrochloride (Brevibloc) is a new ultra-short acting betal selective adrenergic blocking agent. Esmolol bolus 6 and infusion 7 have been found to be effective in attenuating the cardiovascular response to ECT. However, comparison of the effects of different standardized bolus doses and their effect on the Douze patients de classe ASA I-III ont particip~ d trois sdances varides de notre (tude randomisde d double insu sur l'effet de deux doses d'esmolol en bolus (100 et 200 mg) sur les variables hdmodynamiques et la durde des convulsions assocides at•r dlectrochocs ( EC ). On leur injectait I'esmolol ou un placdbo une minute avant I' induction de l'anesthdsie puis detzx minutes avant

Attenuation of Haemodynamic Stress Response to Laryngoscopy and Intubation with two Doses of Esmolol Hydrochloride

“…This is supported by the study by Kovac AL et al (4) RATE PRESSURE PRODUCT The mean rate pressure product in the control group (Group A) showed significant increase (p<0.001) following laryngoscopy and intubation (3, 5, 7 and 10 minute intervals) compared to the two esmolol groups [table 7, chart 11, chart 12, table 9]. This is consistent with studies by Menkhaus PG et al (14) , Murthy VS et al (13) , Liu PL et al (8) , Kovac AL et al (4) and Rathore A et al (5) . Group B showed significant decrease in rate pressure product response following laryngoscopy and intubation at 3 minute interval (p<0.05) and no significant difference (p>0.05) at 5, 7 and 10 minute intervals [table 11].…”

“…This is supported by the study done by Kovac AL et al, where the hemodynamic effects with different doses of esmolol were similar. (4) The study by Rathore A et al conducted in 2002 also showed decrease in heart rate response with all the three doses of esmolol. (5) Thus esmolol 1mg/kg is enough for attenuating the heart rate response to laryngoscopy and intubation.…”

Les β-bloquants sont-ils des anesthésiques ?

“…In the case of esmolol, a dose effect relationship has been noted. 25 There is evidence in the rat that ß-blockers attenuate excitatory neuronal responses in the cingulated cortex 26 or epileptiform responses in the limbic system. 27 The antinociceptive effects of ß-blockers have been noted in rats 28 and in humans with allodynia.…”

“…Dans le cas de l'esmolol, une relation dose-effet a été notée. 25 Chez le rat, les ß-bloquants diminuent les réponses neuronales excitatrices dans le cortex cingulaire 26 ou les réponses épileptiformes dans le système limbique. 27 Les effets antinociceptifs des ß-bloquants ont été démontrés chez les rats 28 et chez les humains avec l'allodynie.…”

Elektrokonvülsif Tedaviye Bağlı Hemodinamik Cevabı Önlemede Esmololün İki Farklı Dozunun Karşılaştırılması

“…Kovac ve arkadaşlarının EKT uygulanan 20 hastada yaptıkları başka bir çalışmada ise, aynı hastanın üç ile beş gün aralarla uygulanan farklı EKT seanslarında plasebo ile esmololün 100 mg ve 200 mg olmak üzere iki farklı bolus dozları verilmiş ve nöbet sürelerine olan etkileri karşılaş-tırılmıştır. Plasebo ile esmololün 100 mg dozu arasında anlamlı bir fark bulunmamışken, esmolol 200 mg verildiğinde plaseboya göre nöbet sürelerinin anlamlı olarak kı-saldığı gözlenmiştir (27).…”