Esmolol bolus and infusion attenuates increases in blood pressure and heart rate during electro-convulsive therapy

Abstract

To determine whether a standardized dose of esmolol can effectively attenuate the cardiovascular response to electroconvulsive therapy (ECT), 17 ASA physical status I-II patients were studied in a randomized within-patient, crossover design. Each patient received "no esmolol" during one ECT and three to five days later crossed over to the alternative treatment receiving an esmolol 80 mg bolus followed by 24 mg.min-1 infusion two minutes prior to induction of anaesthesia and continued for five minutes after induction. Esmolol blunted the maximum increases in heart rate (HR) by 26 per cent, mean arterial pressure (MAP) by 14 per cent, and rate pressure product by 37 per cent with significant differences (P less than 0.05) noted at one, two, three and four minutes after ECT (minutes five, six, seven, and eight of the esmolol infusion). There was no significant difference in seizure duration between the two groups and no adverse reactions occurred.

Electrocardiographic and Blood Pressure Alterations During Electroconvulsive Therapy in Young Adults

“…Lack of adequate control of blood pressure and heart rate during electroconvulsive therapy may lead to important consequences, such as an increase in the risks of sudden death, acute myocardial infarction, meningeal hemorrhage, and strokes. The excessive increase in blood pressure may prolong the period of cognitive disorders in some patients, mainly the elderly, due to the increase in cerebral edema and the passage of neurotoxic macromolecules through the blood-brain barrier during cerebral hyperperfusion [23][24][25] .…”

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

“…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 7 '05 TABLE I Exclusion criteria Pregnant women Less than 21 yr AV conduction block greater than I ~ Systolic BP < 100 mmHg or diastolic BP < 50 mmHg Heart rate < 50 bpm Bronchospasm or bronchial asthma Drug allergy or idiosyncracy to beta-adrenergic drugs Experimental drugs within two weeks Patients on beta blockers or calcium channel blockers (i) compare the effect of two standardized esmolol bolus doses (100 and 200 rag) on heart rate (HR) and blood pressure (BP), and (ii) investigate the effect of these doses on seizure duration during ECT.…”

A randomized, controlled study to compare the effects of intravenous labetalol and esmolol on haemodynamic changes during laryngoscopy and intubation

“…15,16 Different pharmacologic agents like lidocaine, vasodilator agents inhibiting sympathoadrenal response, α and β adrenergic blockers, and opioids can be administered prior to tracheal intubation in order to prevent haemodynamic responses (Helfman et al; Mikawa et al). 4,17 In present study at baseline all the groups were matched for haemodynamic parameters and did not show a significant intergroup difference.…”