Dosing study of esmolol for reducing hemodynamic changes during lightwand intubation

Abstract

Background: Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation.Methods: The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation.Results: The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group.Conclusions: 1–2 mg/kg of a single esmolol injection prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.

Effects of the ultra-short-acting beta-blocker Esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery

“…Esmolol proved to be very efficacious in antagonising haemodynamic changes that accompany laryngoscopy and tracheal intubation. 10,[16][17][18][19] Like in the present study, esmolol prevented increases in blood pressure and heart rate during the phase of tracheal extubation. [20][21][22] Esmolol also assured a more stable haemodynamics during the non-cardiac [23][24][25] and cardiac surgery.…”

Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients

“…27,28 This is why esmolol was viewed as an additional component within thus concept -a so-called 'soft' β-blocker for administration as an iv bolus or iv infusion with a rapid kinetics that allows for its titration to the needs of a specific patient and the particular phase of anaesthesia and operation. [29][30][31] The contribution of esmolol to the concept consists in the decrease in the doses of or the need for administration of intravenous anaesthetics, 32 inhalation anaesthetics, 32,33 opioid analgesics 34 and even neuromuscular relaxants. 35 There are no available publications on the differences in potential beneficial and adverse effects of esmolol regarding the age of the patients.…”

“…Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery equally in younger (aged [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and older patients (aged 65 or more). In both groups, esmolol assured perioperative cardiovascular stability, good recovery after anaesthesia and favourable profile of adverse effects.…”