Esmolol for the Control of Hypertension After Neurologic Surgery

Abstract

We sought to evaluate the effectiveness of esmolol vs placebo in 40 patients emerging from general anesthesia for neurosurgery. Efficacy was defined as a decrease in systolic blood pressure to within 20% above average ward pressure. The need for additional antihypertensive agents to control blood pressure was also used to define efficacy. During the infusion period 20 of 21 (95%) of the esmolol-treated patients and two of 19 (11%) of the patients receiving placebo had return of systolic blood pressure to within 20% of average ward pressure (p < 0.001). One out of 21 (5%) esmolol-treated patients and 14 of 19 (74%) of the placebo group required intervention with additional antihypertensive medications (p < 0.001). Esmolol was found to be effective in controlling hypertension that develops on emergence from general anesthesia in patients undergoing neurosurgery. (CLIN PHARmAcoL THER 1988;44:650-3.)

Acute Arterial Hypertension in Patients undergoing Neurosurgery

“…19 The primary hemodynamic alteration observed in APH is an increase in afterload (systemic vascular resistance [SVR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), with or without tachycardia; there is no difference in cardiac index, left ventricular stroke volume, or left atrial pressure compared with normotensive patients. 8,11,[24][25][26][27] These findings are consistent with a predominant sympathetic-mediated rise in MAP secondary to vasoconstriction. Many preoperative patient characteristics and operative factors may be associated with an increased risk of APH, and several postoperative factors may precipitate increased sympathetic activity, and therefore cause or aggravate APH.…”

Esmolol blunts postoperative hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanesthesia for intracranial surgery

“…Furthermore, labetalol has a longer halflife than esmolol (4.9 hrs), thus possibly inducing undesirable postoperative hypotension [20]. The mean esmolol dose needed to control postoperative hemodynamics in our patients matched that in other similar studies [19][20][21][22]. In our normotensive patients, postoperative hemodynamic changes reverted to normal values with a relatively low dose (500 μg/kg in bolus followed by infusion at a mean rate of 200 ± 50 μg/kg per min), and short infusion time (29 ± 8 min) within a narrow range (1.40-7.45 min).…”

“…To effectively treat ongoing hypertension and tachycardia with esmolol, it is necessary to administer a bolus dose. The esmolol bolus dose regimens tested in the literature [19][20][21] range from 500 μg/kg to 2.0 mg/kg; in our study, we adopted the 500 μg/kg bolus dose, as was previously reported in neurosurgical patients [19,20].…”

“…After neuroanesthesia for intracranial neurosurgery, esmolol attenuates cardiovascular responses to extubation [19][20][21][22] and blunts the increased cerebral blood flow (CBF) velocity during emergence [23]. As a β1-adrenergic blocking drug, esmolol is not a cerebral vasodilator, and it has no significant effect on intracranial pressure (ICP) [24].…”

Emergence hypertension in patients undergoing intracranial surgery

“…Forster et al (4) observed that in anesthetized animals, sudden substantial increases in arterial pressure can result in breach of the blood-brain barrier. The incidence of peri-operative hypertension has been reported to be as wide as 54-91% in various studies (8)(9)(10)(11)(12)(13)(14). Basali et al (15) report an incidence of 57% for postcraniotomy hypertension.…”