Bolus administration of esmolol for controlling the hemodynamic response to laryngoscopy and intubation: Efficacy and effects on myocardial performance

Category Primary study
JournalJournal of Cardiothoracic Anesthesia
Year 1990
Bolus administration of esmolol offers a practical alternative to continuous infusion of this drug for attenuating the cardiovascular response to transient noxious stimuli such as tracheal intubation. Doseresponse, and effects on cardiac function, have not been defined for esmolol when given as a bolus during induction of anesthesia. A placebo-controlled, double-blind study of 45 vascular surgery patients with risk factors for coronary artery disease was undertaken. Prior to induction, patients received fentanyl, 2 μg/kg, intravenously, and a bolus of either normal saline (PLAC), esmolol, 1.5 mg/kg (ESM1.5), or esmolol, 3.0 mg/kg (ESM 3.0). Anesthesia was induced with thiopental, 3.0 mg/kg, and succinylcholine, 1.5 mg/kg, followed by tracheal intubation 60 seconds later. In response to intubation, heart rate and mean arterial pressure (MAP) increased by 20 ± 9 beats/min and 18 ± 14 mm Hg, respectively, in the PLAC group (P < 0.05), but did not change with either dose of esmolol. However, there was a transient, but significant, decrease in MAP following induction in the ESM 3.0 group [P < 0.05). A small decrease in cardiac index was also observed in both ESM groups [P < 0.05), without a significant change in either stroke volume index or ejection fraction when compared with PLAC. Myocardial ischemia was not detected in any patient (ECG lead V5). It is concluded that esmolol, administered as a 1.5 mg/kg bolus prior to induction of anesthesia, is the optimal dose for providing effective control of the hemodynamic response to tracheal intubation.
Epistemonikos ID: 4698117d76827e33cfb888b5a7c436977ae3786f
First added on: Mar 15, 2014