Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review

Abstract

Introduction and aimsEsmolol is an ultra-short-acting β1 antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI.Materials and methodsPubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension.ResultsSeven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted.ConclusionCompared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval).Trial registration numberCRD42018090282.

Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy

“…These findings go in hand with previous studies that reported significant blunting of pressor reflexes to LTI with esmolol injection compared to placebo,[22] diltiazem[23] and lidocaine. [2425] In support of the efficiency of the priming dose of esmolol, Thiruvenkatarajan et al [26] screened the published databases for randomized controlled trials comparing the effect of esmolol and placebo on the corrected QT (QTc) interval prolongation associated with LTI in patients undergoing cardiac and noncardiac surgeries and found esmolol significantly reduced the QTc and protected the heart against intubation-induced arrhythmias.…”

Is there a treatment for SARS-CoV-2?

“…Maintain the satisfactory patient rhythm and address any electrolyte and QTc abnormalities focusing on the use of b-1 selective agonist [5]. Attention to be given to complement cascade clotting and glycoprotein IIb/IIIa issues resulting from ITR.…”

“…However, these efforts have exposed both a haphazard approach to medicine, prescribing treatments in the absence of scienti c evidence, as well as the political issues associated with the investigation of SARS-CoV-2 origin and treatment. This investigation looked at 10 different treatments coupled with (a) efforts to reduce the use of ventilators promoting prone positioning or alternative methods of improved oxygenation to reduce ventilator deaths associated with ARDS [3,4], (b) immune system augmentation using associated vitamins and minerals demonstrated to be important for best case scenario immune response [2] along with supplementation of magnesium and other medications [5] to reduce problems related to the use of aminoquinolines and other medications that prolong QTc, and (c) the use of nebulized medications when possible including the inclusion of Atrovent to reduce bronchial secretions and promote airway dilatation to improve air ow without increasing heart rate or altering QTc.…”

“…Further treatments were determined by other medications the patients might have already been receiving or required by hospital protocol. The use of Esmolol [5] for heart rate and QTc regulation was determined by Cardiology. Patients were also given 5000 units of subcutaneous Heparin every 12hours to reduce formation of thrombi.…”

Is there a treatment for SARS-CoV-2?

“…The use of Esmolol [5] for heart rate and QTc regulation was determined by Cardiology. Patients were also given 5000 units of subcutaneous Heparin every 12hours to reduce formation of thrombi.…”