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Background: Ambulatory procedures have a universal objective of rapid, efficient and secure recovery and release. Preliminary advances utilizing intraoperative esmolol infusion have registered a postoperative opioid saving outcomes. In the current study, we compared intraoperative esmolol versus magnesium sulphate infusions on postoperative recovery profile and stay in the postanaesthesia care unit (PACU). Patients and methods: Sixty patients, of both sexes, of ASA I or II planned for ambulatory laparoscopic cholecystectomy under general anaesthesia were engaged into two groups. Esmolol group was given loading dose (1 mg/kg) over a period of 10 minutes followed by (30 µg/kg/min) all through the surgery, whereas magnesium sulphate (MgSo4) group was given loading dose (40 mg/kg) over 10 minutes then maintenance dose (15 mg/kg/h) till end of surgery. General anaesthesia and postoperative analgesia were standardized for all patients. Variables denoting immediate recovery from anaesthesia, pain score and time for first call to analgesia were recorded. White-Song score = 12 were employed as a tool to review the rapidity of recovery. Results: Compared to MgSo4 group, the esmolol group exhibited statistically significant shorter times for sponteaous eye opening, tongue extension, extubation and patients' capability to recall their names. Incidence of vomiting as well as the total amount of ondansetron consumed in the PACU were evidently less among the esmolol group, whereas pain scores and the time of recall for first rescue analgesia did not vary significantly among the two studied groups. Members of the esmolol group displayed significant higher White-Song score at all times of measurements except at 120 minutes compared to those of MgSo4 group. Conclusions: Perioperative esmolol infusion is accompanied by superior and fast-tracked recovery profile compared to MgSo4 infusion. [ABSTRACT FROM AUTHOR]

Background: Refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest describes a subset of patients who do not respond to standard Advanced Cardiac Life Support (ACLS) interventions and are associated with poor outcomes. Esmolol administration and vector change defibrillation have shown promise in improving outcomes in these patients, however evidence is limited.Objectives: This study compares clinical outcomes between patients with prehospital refractory VF/pVT who received an Emergency Medical Service (EMS) bundle, comprised of esmolol administration, vector change defibrillation, and dose-capped epinephrine at 3 mg, to patients who received standard ACLS interventions.Methods: This multicenter, retrospective, cohort study evaluated medical records between October 18, 2017 and March 15, 2022. Patients were enrolled if they experienced a prehospital cardiac arrest with the rhythm VF or pVT, had received at least three standard defibrillations, at least 3 mg of epinephrine, and 300 mg of amiodarone. Patients who received the EMS bundle after its implementation were compared to patients who received standard ACLS interventions prior to its implementation. The primary outcome was sustained return of spontaneous circulation (ROSC), defined as ROSC lasting 20 min without recurrence of cardiac arrest. Secondary outcomes included the incidence of any ROSC, survival to hospital arrival, survival at hospital discharge, and neurologically intact survival at hospital discharge.Results: Eighty-three patients were included in the study. Thirty-six were included in the pre-EMS bundle group and 47 patients were included in the post-EMS bundle group. Patients in the pre-EMS bundle group achieved significantly higher rates of sustained ROSC (58.3% vs 17%, p < 0.001), any ROSC (66.7% vs 19.1%, p < 0.001), and survival to hospital arrival (55.6% vs 17%, p < 0.001). The rates of survival to hospital discharge (16.7% vs 6.4%, p = 0.17) and neurologically intact survival at hospital discharge (5.9% vs 4.3%, p = 1.00) were not significantly different between groups.Conclusions: Patients who received the EMS bundle achieved sustained ROSC significantly less often and were less likely to have pulses at hospital arrival. The incidence of neurologically intact survival was low and similar between groups. [ABSTRACT FROM AUTHOR]

• Methylxanthine toxicity can cause life-threatening tachyarrhythmias and hypotension. • Esmolol treats the tachyarrhythmias but unavailability and hypotension limit its use. • Digoxin is a potential alternative treatment with desirable properties. • Digoxin controls heart rate, does not worsen hypotension, and is widely available. Caffeine and theophylline use can lead to methylxanthine toxicity, resulting in life-threatening tachyarrhythmias and hypotension. Esmolol, a beta-adrenergic antagonist, is a suggested option for controlling associated tachyarrhythmias. However, esmolol is not universally available, and its hypotensive effects often deter its use. Digoxin, another rate control agent which is widely available, theoretically possesses the circulatory system effects needed to tackle both tachyarrhythmia and hypotension induced by methylxanthine toxicity. We propose digoxin as an alternative to esmolol, especially in regions where esmolol is unavailable and for individuals experiencing hypotension due to methylxanthine toxicity. [ABSTRACT FROM AUTHOR]

Both intraoperative esmolol and transversus abdominis plane (TAP) block facilitate postoperative analgesia after laparoscopic cholecystectomy as part of multimodal analgesia. Both strategies can minimize the use of postoperative opioids. In current study, our goal was to assess if intra-operative esmolol infusion in association with TAP block can overcome the deficits of TAP block alone after laparoscopic cholecystectomy. This prospective, randomized and double-blinded clinical trial included 60 patients of either sex who scheduled for elective laparoscopic cholecystectomy; received either ultrasound-guided TAP block alone or in association with intravenous esmolol bolus (0.5 mg/kg) before induction followed by a maintenance infusion (0.05 mg/kg/min) till the end of operation. Intra-operative hemodynamic parameters were followed up. Postoperatively, in order to maintain visual analogue scale (VAS) scores ≤3, patients received IV morphine. The primary outcome was amount of opioid consumption during the first 24 hours postoperative. Pain scores, mean arterial pressure (MAP), heart rate (HR) and occurrence of nausea/vomiting were secondary outcomes. The mean morphine consumption after surgery in patients receiving esmolol was (5.83) mg compared to (7.5) mg in TAP only group (p = 0.204). The mean pain scores at early postoperative hours were significantly lower in esmolol group (p < 0.05). MAP and HR were significantly lower in esmolol group intraoperative; however, no variance was detected later. In the first 24 hours following surgery, esmolol infusion increased the analgesic impact of TAP block in terms of opioid demand and pain severity. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To assess whether the administration of the ultra-short–acting β-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes. Single-center, double-blinded, parallel-group randomized controlled trial. A tertiary care referral center. Patients undergoing elective cardiac surgery with preoperative evidence of left ventricular end-diastolic diameter >60 mm and/or left ventricular ejection fraction <50%. Patients were assigned randomly to receive either esmolol (1 mg/kg as a bolus before aortic cross-clamping and 2 mg/kg mixed in the cardioplegia solution) or placebo in a 1:1 allocation ratio. The primary composite endpoint of prolonged intensive care unit stay and/or in-hospital mortality occurred in 36/98 patients (36%) in the placebo group versus 27/102 patients (27%) in the esmolol group (p = 0.13). In the esmolol group, a reduction in the maximum inotropic score during the first 24 postoperative hours was observed (10 [interquartile range 5-15] v 7 [interquartile range 5-10.5]; p = 0.04), as well as a trend toward a reduction in postoperative low-cardiac-output syndrome (13/98 v 6/102; p = 0.08) and the rate of hospital admission at one year (26/95 v 16/96; p = 0.08). A trend toward an increase in the number of patients with ejection fraction ≥60% at hospital discharge also was observed (4/95 v 11/92; p = 0.06). In the present trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac performance but did not reduce a composite endpoint of prolonged intensive care unit stay and/or mortality. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Unlike echocardiography, cardiac magnetic resonance imaging (cardiac MRI) results in a near-exact assessment of cardiac structures and function. However, most veterinary studies have focused on dogs with normal cardiac function. We hypothesized that there would be significant differences in cardiac measurements between cardiac MRI and echocardiography when left ventricular (LV) function was abnormal. This study was undertaken to compare measurements of LV function produced by cardiac MRI and echocardiography in dogs whose LV function was altered by pharmacological agents. This study was conducted with six healthy beagle dogs. We increased left ventricular contractility by administration of dobutamine; we decreased cardiac contractility with esmolol. Stroke volume measurements were made by using both cardiac MRI and echocardiography under seven different conditions with general anesthesia: control, three doses of esmolol (100, 200, and 500 µg/kg/min), and three doses of dobutamine (10, 20, and 50 µg/kg/min). Experiments involving each condition were conducted at least 1 week apart. When LV contractility was normal, ejection fraction (EF) and stroke volume (SV), as measured by echocardiography and cardiac MRI, were not significantly different. However, when contractility was changed by pharmacological agents, EF and SV were overestimated by echocardiography, compared to MRI. Evaluation of cardiac function in patients treated with pharmacological agents should be conducted carefully because EF and SV measured by echocardiography can be overestimated, compared with EF and SV obtained by cardiac MRI. [ABSTRACT FROM AUTHOR]

Background: Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).Objectives: We performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care.Methods: MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated.Results: The search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01-7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11-10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low).Conclusion: The effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence. [ABSTRACT FROM AUTHOR]

Study Objectives: The purpose of this review is to provide a brief overview of new life-saving interventions and novel techniques that have been proposed as viable treatment options for patients presenting with refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest (OHCA).Methods: We conducted a comprehensive literature search of PubMed recent, Medline and Embase databases via the Ovid interface and Google Scholar from inception to July 2019. Eligible studies were observational in nature reporting outcomes of extracorporeal membrane oxygenation (ECMO), esmolol, double sequential defibrillation (DSD), and stellate ganglion block (SGB). Two investigators conducted the literature search, study selection, and data extraction. Any disagreements were resolved by consensus.Results: Our database search identified 5331 records. We included in our review 23 articles that met our inclusion criteria. The selected studies included 16 observational studies on ECMO, 2 observational studies on esmolol, and 5 observational studies on DSD.Conclusion: We would like to suggest that there is not enough evidence in the existing literature to support at large-scale the effects of these techniques in the treatment of refractory VF/pVT OHCA. Randomized studies are warranted to evaluate the significant effects of these approaches against the best current standard of care. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage (ICH) is responsible for approximately 15% of strokes annually in the United States, with nearly 1 in 3 of these patients dying without ever leaving the hospital. Because this disproportionate mortality risk has been stagnant for nearly 3 decades, a main area of research has been focused on the optimal strategies to reduce mortality and improve functional outcomes. The acute hypertensive response following ICH has been shown to facilitate ICH expansion and is a strong predictor of mortality. Rapidly reducing blood pressure was once thought to induce cerebral ischemia, though has been found to be safe in certain patient populations. Clinicians must work quickly to determine whether specific patient populations may benefit from acute lowering of systolic blood pressure (SBP) following ICH. This review provides nurses with a summary of the available literature on blood pressure control following ICH. It focuses on intravenous and oral antihypertensive medications available in the United States that may be utilized to acutely lower SBP, as well as medications outside of the antihypertensive class used during the acute setting that may reduce SBP. [ABSTRACT FROM AUTHOR]

Purpose: Acute aortic dissection is a serious and life-threatening condition that requires prompt, effective management. The purpose of this study was to evaluate the efficacy and safety of esmolol for heart rate control in patients with acute aortic dissection in the Emergency Department (ED).Methods: This was a retrospective, descriptive analysis of patients treated for type A or type B acute aortic dissection in the ED at an academic medical center. The primary outcome was the proportion of patients achieving strict (≤60 bpm) or lenient (≤80 bpm) heart rate control within the first 60 min of therapy at the study site. The primary safety endpoint was the incidence of hypotension, defined as a systolic blood pressure of <90 mmHg or a mean arterial pressure of ≤60 mmHg.Results: Of 266 patients screened, 40 patients met inclusion criteria. Thirty-three patients (82.5%) attained lenient rate control within the first 60 min of esmolol therapy. Eleven patients (27.5%) achieved a strict heart rate goal within the first 60 min of esmolol therapy. Five patients (12.5%) experienced an episode of hypotension during the first 3 h of esmolol therapy.Conclusion: In patients treated with esmolol infusion for acute aortic dissection, a lenient HR goal was achieved in most patients. In contrast, esmolol was not associated with attainment of strict HR control in most patients included in this sample. Further studies are warranted to evaluate the exact role of esmolol in acute aortic dissection in a larger patient population. [ABSTRACT FROM AUTHOR]

β-Blockers are useful drugs in several clinical cardiologic scenarios. Their use in the perioperative period and in critically ill patients is increasing, but their effect on clinically relevant outcomes remains controversial. Long-acting β-blockers can have detrimental effects that are difficult to be counteracted in these settings. The authors describe the possible clinical uses of ultra-short–acting β-blockers (esmolol and landiolol) in the perioperative period and in critically ill patients because these drugs have the beneficial effects of β-blockers, but do not have the detrimental effects of long-acting agents. This narrative review focuses on ultra-short–acting β-blockers in the following clinical settings: prevention and treatment of arrhythmias and myocardial ischemia in noncardiac and cardiac surgery, usage as cardioplegia adjuvants or to test the reversibility of systolic anterior motion of the mitral valve in cardiac surgery, medical treatment of aortic dissection before surgery, improvement of microcirculation and oxygenation in critically ill patients experiencing sepsis or undergoing extracorporeal membrane oxygenation, anesthesia induction, and coronary computed tomography angiography. [ABSTRACT FROM AUTHOR]

Objectives To evaluate outcome of elective abdominal myomectomy under esmolol hypotensive anesthesia (HA) compared to normotensive anesthesia (NA). Methods Patients were randomly divided into NA Group received NA and HA Group received esmolol (0.5 mg/kg) bolus then infusion (0.05–0.3 mg/kg/min) to maintain mean arterial pressure at 60–70 mmHg till completion of myomectomy. Masimo Radical 7 was used to monitor regional cerebral oxygenation (rSO 2 ), total hemoglobin (Hb.) and pleth variability index (PVI). Fluid therapy (FT) included initial bolus of 5% human plasma protein followed by intraoperative (IO) Lactated Ringer's (LR) solution. Amount of IO blood loss, blood transfusion and urine output (UOP) were determined. Postoperative (PO) Hb. conc. was measured at laboratory (Lab). Results IO blood pressure was significantly lower, while PVI was significantly higher with significantly lower ΔPVI with HA than NA. Operative time was significantly shorter with significantly less IO blood loss and blood transfusion with HA. Regional cerebral and peripheral tissue oxygen saturations showed non-significant difference between both groups. PO Masimo measured and Lab estimated Hb. was significantly higher with significantly lower ΔHb% in HA than NA group. Masimo measurement was significantly higher with significantly lower ΔHb% than lab estimation in both groups. Patients of NA group received significantly greater amount of LR, but UOP was non-significantly higher than in HA group. Conclusion Esmolol HA allowed better control of IO bleeding, blood transfusion and FT. Masimo continuous monitoring of rSO2 assured preserved cerebral perfusion. Masimo measured PVI could non-invasively monitor tissue perfusion. [ABSTRACT FROM AUTHOR]

Background: Esmolol may have some potential in treating septic shock and sepsis. However, the results remain controversial. We conduct a systematic review and meta-analysis to explore the efficacy of esmolol in patients with septic shock and sepsis.Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of esmolol for septic shock and sepsis are included. Two investigators independently search articles, extract data, and assess the quality of included studies. Meta-analysis is performed using the random-effect model.Results: Five RCTs are included in the meta-analysis. Overall, compared with control intervention in septic patients, esmolol intervention is found to significantly increase survival rate (risk ratio (RR)=2.06; 95% confidence interval (CI)=1.52 to 2.79; P=0.006), decrease heart rate (Standard Mean difference (Std. MD)=-2.43; 95% CI=-4.13 to -0.72; P=0.005) and TnI (Std. MD=-1.91; 95% CI=-2.39 to -1.43; P<0.00001), but has no significant impact on mean arterial pressure (MAP) (Std. MD=0.11; 95% CI=-0.21 to 0.44; P=0.49), central venous pressure (CVP) (Std. MD=-0.11; 95% CI=-0.50 to 0.28; P=0.58) and central venous oxygen saturation (ScvO2) (Std. MD=1.87; 95% CI=-1.53 to 5.26; P=0.28).Conclusions: Esmolol treatment may be able to improve survival rate, and reduce heart rate and TnI, but has no influence on MAP, CVP and ScvO2 in patients with septic shock and sepsis. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the efficacy of intravenous infusion of clevidipine or esmolol for producing controlled hypotension during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. Patients and methods Fifty adult ASA I and II patients scheduled for endoscopic repair of CSF rhinorrhea were randomized into one of two groups. Group C (25 patients) received clevidipine 0.5 mcg/kg/min increased by 0.5 mcg/kg/min every 3–5 min to achieve the target mean arterial pressure (MAP) of 55–65 mmHg. Group E (25 patients) received esmolol infusion 50 mcg/kg/min increased by 50 mcg/kg/min every 3–5 min to achieve the target MAP. Surgical field Quality, blood loss, haemodynamic parameters, surgeons' satisfaction and adverse events were recorded. Results Time to reach target MAP was significantly shorter in group C compared to group E. Number of patients needed nitroglycerine was significantly higher in group E compared to group C (8 versus 2 respectively). The nitroglycerine dose needed/patient in group E was significantly more compared to group C. Surgeon satisfaction score was significantly higher in group C compared to group E. More patients in group E developed bradycardia compared to group C. Mean arterial pressure was significantly lower in group C compared to group E after 5 and 10 min from the start of the studied drugs infusion while it was significantly higher in group C after 25 min from the start of the studied drugs. The heart rate (HR) was significantly lower in group E compared to group C 10 min after starting drugs infusion till the end of surgery. Conclusion Both clevidipine and esmolol are effective for inducing controlled hypotension during endoscopic repair of CSF rhinorrhea. Clevidipine has the advantage of having shorter time to reach target MAP with less need of additional hypotensive agent and better surgeon satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Esmolol is a highly selective beta 1 receptor blocker with various effects such as slowing heart rate, lowering blood pressure and reducing myocardial oxygen consumption. However, few studies have reported the use of beta blockers in sepsis with multiple organ dysfunctions. This study aimed to investigate the effects of esmolol on reducing apoptosis and inflammation in early sepsis rats with abdominal infection.Methods: Rats were randomly divided into sham operation group, sepsis group, antibiotic group, Esmolol + antibiotic group with low, median and high dose Esmolol (L group, M group and H group). Values between two or more groups were compared by independent t-tests.Results: In the liver and kidney, we found inflammatory infiltration in sepsis group while pathological aspects reduced in L, M and H groups. Bcl-2 mRNA and protein levels increased while Bax mRNA and protein levels decreased in the liver and kidney of L, M and H groups. Serum IL-6, HMGB-1 and TNF-α levels decreased but IL-10 level increased in L, M and H groups, compared to sepsis group. Compared to sepsis and antibiotic groups, the levels of myocardial enzymes were lower in L, M and H groups.Conclusion: The administration of esmolol in early sepsis may reduce inflammation, inhibit apoptosis and protect key organs. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Esmolol hydrochloride injection is indicated for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short term control of ventricular rate with a short-acting agent is desirable. The potential toxic impurities in pharmaceuticals at micro levels or trace levels are of increasing concern to both pharmaceutical industries and regulatory agencies, due to their potential risk to human health. The impurity investigation of esmolol remains incomplete. Thereby, efficient impurities monitoring and potential toxicity assessment should be emphasized to assure drug safety. Impurity profiling methods of esmolol were developed using ultraperformance liquid chromatography plus Q-Exactive Orbitrap tandem mass spectrometry (UPLC-QE-MS) based multiple mass defect filter and chemometrics. Impurities were characterized by both UPLC-QE-MS and reference substance comparison. The toxicities of esmolol impurities were predicted by employing quantitative structure–activity relationship. The results showed that a total of 20 impurities were detected and identified using the above integrated strategy, 14 impurities (EP2-3 , EP5-6 , EP8-9 , EP12-13 , EP15-20) have firstly found. EP20 was predicted as hepatotoxic and mutagenic using QSAR model, and its hepatotoxicity were verified in vivo. The EP1 contents showed maximum volatility in all batches, and varied by sample. EP1 and its accompanying product of methanol were measured. This UPLC-MS/MS based chemometrics strategy is useful for monitoring the manufacturing process and quality control of esmolol hydrochloride injection. [ABSTRACT FROM AUTHOR]

Objectives: Cerebral hypoxic-ischaemic injury following cardiac arrest is a devastating disease affecting thousands of patients each year. There is a complex interaction between post-resuscitation injury after whole-body ischaemiareperfusion and cerebral damage which cannot be explored in in vitro systems only; there is a need for animal models. In this study, we describe and evaluate the feasibility and efficiency of our simple rodent cardiac arrest model. Methods: Ten wistar rats were subjected to 9 and 10 minutes of cardiac arrest. Cardiac arrest was introduced with a mixture of the short-acting beta-blocking drug esmolol and potassium chloride. Results: All animals could be resuscitated within 1 minute, and survived until day 5. General health score and neurobehavioural testing indicated substantial impairment after cardiac arrest, without differences between groups. Histological examination of the hippocampus CA1 segment, the most vulnerable segment of the cerebrum, demonstrated extensive damage in the cresyl violet staining, as well as in the Fluoro-Jade B staining and in the Iba-1 staining, indicating recruitment of microglia after the hypoxic-ischaemic event. Again, there were no differences between the 9- and 10-minute cardiac arrest groups. Discussion: We were able to establish a simple and reproducible 9- and 10-minute rodent cardiac arrest model with a well-defined no-flow-time. Extensive damage can be found in the hippocampus CA1 segment. The lack of difference between 9- and 10-minute cardiac arrest time in the neuropsychological, the open field test and the histological evaluations is mainly due to the small sample size. [ABSTRACT FROM AUTHOR]

Resumo Objetivo Comparar os efeitos de infusões de lidocaína e esmolol sobre as alterações hemodinâmicas no período intraoperatório, a necessidade de analgésicos intra‐ e pós‐operatoriamente e a recuperação após colecistectomia laparoscópica. Métodos O primeiro grupo (n = 30) recebeu infusões IV de lidocaína a uma taxa de 1,5 mg/kg/min e o segundo grupo (n = 30) recebeu infusões IV de esmolol a uma taxa de 1 mg kg/min. Alterações hemodinâmicas, necessidade de analgésicos no intra‐ e pós‐operatório e características da recuperação foram avaliadas. Resultados No grupo lidocaína, os valores da pressão arterial sistólica foram menores após a indução da anestesia e 20 minutos após a incisão cirúrgica ( p < 0,05). O tempo até o despertar foi menor no grupo esmolol ( p < 0,001), os escores na escala de Sedação de Ramsay 10 minutos após a extubação foram menores no grupo esmolol ( p < 0,05). Os escores de Aldrete modificados em todos os tempos mensurados durante o período de recuperação foram relativamente baixos no grupo lidocaína ( p < 0,05). O tempo necessário para atingir um escore de Aldrete ≥ 9 pontos foi prolongado no grupo lidocaína ( p < 0,01). Os escores Eva em repouso e em movimento no pós‐operatório foram maiores no grupo lidocaína nos minutos 10 e 20 após a extubação ( p < 0,05, p < 0,01, respectivamente). Analgésicos suplementares foram necessários com menos frequência no grupo lidocaína ( p < 0,01). Conclusão Em colecistectomia laparoscópica, a infusão de lidocaína foi superior às infusões de esmolol quanto a suprimir as respostas à extubação traqueal e necessidade de analgésicos adicionais no pós‐operatório, enquanto esmolol foi mais vantajoso quanto à rápida recuperação da anestesia, à atenuação da dor no pós‐operatório imediato e aos escores de recuperação de Aldrete modificado (RAM) e o tempo até atingir o escore RAM de 9 pontos. Objective We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. Methods The first group ( n = 30) received IV lidocaine infusions at a rate of 1.5 mg/kg/min and the second group ( n = 30) received IV esmolol infusions at a rate of 1 mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. Results In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20 min following surgical incision ( p < 0.05). Awakening time was shorter in the esmolol group ( p < 0.001); Ramsay Sedation Scale scores at 10 min after extubation were lower in the esmolol group ( p < 0.05). The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group ( p < 0.05). The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group ( p < 0.01). Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20 min after extubation ( p < 0.05, p < 0.01, respectively). Analgesic supplements were less frequently required in the lidocaine group ( p < 0.01). Conclusion In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR) scores and time to reach MAR score of 9 points. [ABSTRACT FROM AUTHOR]

Hypertensive left ventricular hypertrophy (LVH) is a maladaptive response to chronic pressure overload and a strong independent risk factor for cardiovascular disease. Regression of LVH is associated with improved prognosis. Regression of LVH with antihypertensive therapy (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and diuretics) has been reported, although only after long-term treatment. Asymmetrical dimethylarginine (ADMA), the most potent endogenous NO synthase inhibitor, is emerging as an important cardiovascular risk factor in patients with arterial hypertension and LVH, and dimethylarginine dimethylaminohydrolase (DDAH) is the mechanism that most frequently leads to accumulation of ADMA (plasma ADMA is cleared in small part by renal excretion, although the bulk of ADMA is degraded by DDAH). Left ventricular mass is strongly modulated by the NO system. As an important inhibitor of the bioavailability of NO, ADMA is an underlying mechanism of LVH. Beta-blockers can induce regression of LVH and reduced plasma ADMA levels. Oxidative stress is increased in patients with LVH, and this in turn increases generation of ADMA. In a previous preclinical study of spontaneously hypertensive rats, we found that short-term treatment (48 h) with esmolol reverses early LVH, increases the bioavailability of NO, and improves antioxidant status in plasma. Therefore, we propose that the ADMA/DDAH/NO pathway could modulate early regression of LVH with esmolol. [ABSTRACT FROM AUTHOR]

Background Laparoscopic surgical procedures have various benefits to the patient in terms of decreased tissue damage, early ambulation, decreased hospital stay and reduced analgesic needs. Pneumoperitoneum with carbon dioxide (CO 2 ) leads to stimulation of the sympathetic nervous system which can be a risk factor in patients with cardiovascular diseases. Moreover, reverse Trendelenburg position affects homeostasis in laparoscopic surgeries. In this study, we compared the efficacy of clonidine (which is α2 adrenergic agonist) versus esmolol (which is ultra short acting cardio-selective β1-receptor antagonist) on the hemodynamic response during laparoscopic cholecystectomy. Materials and methods A total of 60 patients scheduled to undergo laparoscopic cholecystectomy were randomly assigned into two groups: Group C: received 2 μg/kg of clonidine diluted in 20 ml normal saline, given with slow intravenous infusion over 10 min just before induction of GA and Group E: received 1.5 mg/kg of esmolol as a loading dose over a period of 5 min just before induction of GA followed by 10 μg/kg/min as a maintenance dose throughout the procedure. No hypnotic medication was given on the evening before surgery. Systolic, diastolic, mean arterial blood pressures and heart rate were recorded at (1) baseline, (2) three minutes after endotracheal intubation, (3) before pneumoperitoneum, (4) fifteen minutes after pneumoperitoneum, (5) thirty minutes after pneumoperitoneum, (6) five minutes after release of CO 2 and (7) five minutes after extubation. Degree of sedation according to Ramsay sedation score was assessed 15 min after reaching PACU. Results Both groups were similar with respect to demographic data. Clonidine group showed more stability in hemodynamic responses than esmolol group in all hemodynamic variables but with more postoperative sedation. Conclusion This study concluded that clonidine and esmolol provide hemodynamic stability in laparoscopic cholecystectomy but clonidine provides more stability with postoperative sedation. [ABSTRACT FROM AUTHOR]

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Objective This study investigated if the β-receptor blocking agent esmolol, added to standard oxygenated blood cardioplegia, improved myocardial function after weaning from bypass. Design A block-randomized, blinded study. Setting A university laboratory. Participants Twenty anesthetized pigs, Norwegian Landrace. Interventions After cardiopulmonary bypass, cardiac arrest was induced with cold (12°C), oxygenated blood cardioplegia, enriched with either esmolol or vehicle, repeated every 20 minutes. After 100 minutes the heart was reperfused and weaned. Measurements and Main Results Left ventricular function was evaluated with pressure-volume loops, local myocardial function with multilayer strain and strain rate by epicardial short-axis tissue Doppler imaging. One hour after declamping, preload recruitable stroke work did not differ between groups, but increased to 72±3 mmHg in esmolol-treated animals v 57±4 mmHg (p<0.001) in controls after 3 hours. Radial peak ejection strain rate also was increased by esmolol; 6.0±1.0 s −1 v 2.9±0.3 s −1 (p<0.001) in subendocardium and 3.9±0.5 s −1 v 2.3±0.2 s −1 (p<0.005) in the midmyocardium. Cardiac index was increased, 4.0±0.2 L/min/m 2 by esmolol v 3.3±0.1 L/min/m 2 for controls (p<0.05). Isovolumetric relaxation time constant was reduced by esmolol, 23±1 ms v 26±1 ms (p<0.025). Troponin-T did not differ and was 339±48 ng/L for the esmolol group and 357±55 ng/L for the control group (p = 0.81). Conclusions Esmolol added to blood cardioplegia preserved systolic cardiac function during the first 3 hours after reperfusion in a porcine model with 100 minutes of cardioplegic arrest. [ABSTRACT FROM AUTHOR]

Background Upon recovery from anesthesia and during extubation, there will be mechanical stimulation of receptors in the respiratory tract that results in both respiratory and cardiovascular reflex responses. Heart rate plays a major determinant of myocardial oxygen consumption and cardiac workload, so decreasing the heart rate will increase the ischemic threshold and improve the cardiac performance. Objective To evaluate the effect of esmolol infusion on myocardial oxygen consumption during extubation and quality of recovery in elderly patients undergoing general anesthesia. Methods Hundred adult patients ASA I & II scheduled for elective open unilateral inguinal hernia were randomized, double-blindly into one of two parallel groups, esmolol group (E) ( n = 50) and control group (C) ( n = 50). In the esmolol group, 1 mg/kg esmolol was given as bolus over 30 s then followed by a continuous esmolol infusion of 100 μg/kg/min starting 10 min before end of surgery till 5 min after extubation. While patients in group C received normal saline bolus of the same volume followed by a continuous normal saline infusion of the same volume per hour as group E. Mean heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), rate pressure product (RPP), anesthesia time, recovery time, postoperative nausea & vomiting, number of doses of antiemetic agent and quality of extubation were recorded. Results The results showed that patients in the esmolol group had lower values of (RPP) after esmolol infusion with statistically significant difference when compared with patients in the control group using unpaired t -test ( P < 0.05), this will decrease oxygen consumption in esmolol group. Also, there was statistically significant difference between both groups regarding values of HR (beat/min), SBP (mmHg), DBP (mmHg) and MBP (mmHg) starting 2 min after esmolol infusion and continued till 10 min after extubation using unpaired t -test ( p < 0.05). As regards PONV, there was lower incidence in esmolol group when compared to control group using unpaired t -test with statistically significant difference ( P < 0.05). Conclusions Esmolol is a safe, effective and well-tolerated drug that can be used in elderly patients undergoing general anesthesia to reduce the myocardial oxygen consumption and improve the quality of recovery. [ABSTRACT FROM AUTHOR]

Resumo Objetivo A dor e a incidência de náusea e vômito no período pós‐operatório (NVP) são comuns em pacientes submetidos à colecistectomia laparoscópica. Os agentes simpatolíticos podem diminuir a necessidade de opiáceos ou anestésicos inalatórios ou intravenosos. Neste estudo, nosso objetivo foi analisar os efeitos de esmolol sobre a necessidade de anestésico no período intraoperatório e de analgésico no pós‐operatório e a incidência de dor e NVP. Métodos Sessenta pacientes foram incluídos. Propofol, remifentanil e vecurônio foram usados para a indução. Os grupos de estudo foram os seguintes: grupo I , a infusão de esmolol foi adicionada aos anestésicos (propofol e remifentanil) para manutenção; grupo II , apenas propofol e remifentanil foram usados durante a manutenção; grupo III , a infusão de esmolol foi adicionada aos anestésicos (desflurano e remifentanil) para manutenção; grupo IV , apenas desflurano e remifentanil foram usados durante a manutenção. O período de acompanhamento foi de 24 horas para avaliar a incidência de NVP e a necessidade de analgésicos. Os escores de dor também foram avaliados por meio da escala visual analógica (EVA). Resultados Os escores EVA foram significativamente menores no grupo I (p = 0,001‐0,028). A incidência de NVP foi significativamente menor no grupo I (p = 0,026). NVP também foi menor no grupo III em relação ao grupo IV (p = 0,032). A necessidade de analgésicos foi significativamente menor no grupo I e menor no grupo III em relação ao grupo IV (p = 0,005). A frequência cardíaca foi significativamente menor nos grupos esmolol (grupos I e III ) comparados com os controles (p = 0,001), mas a pressão arterial foi semelhante em todos os grupos (p = 0,594). A comparação entre os grupos esmolol e controles revelou que houve uma diminuição. Conclusão O uso de esmolol durante a manutenção da anestesia reduz significativamente a necessidade de anestésico‐analgésico, dor e incidência de NVP. Purpose Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic‐postoperative analgesic requirements, postoperative pain and PNV. Methods Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II – Only propofol and remifentanil was used during maintenance, III – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. Results VAS scores were significantly lowest in group I (p = 0.001–0.028). PNV incidence was significantly lowest in group I (p = 0.026). PNV incidence was also lower in group III compared to group IV (p = 0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005). Heart rates were significantly lower in esmolol groups (group I and III ) compared to their controls (p = 0.001) however blood pressures were similar in all groups (p = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024–0.03). Conclusion Using esmolol during anesthetic maintenance significantly decreases anesthetic‐analgesic requirements, postoperative pain and PNV. [ABSTRACT FROM AUTHOR]

Background Coronary CT angiography (CTA) is an established tool to rule out coronary artery disease. Performance of coronary CTA is highly dependent on patients' heart rates (HRs). Despite widespread use of β-blockers for coronary CTA, few studies have compared various agents used to achieve adequate HR control. Objective We sought to assess if the ultrashort-acting β-blocker intravenous esmolol is at least as efficacious as the standard of care intravenous metoprolol for HR control during coronary CTA. Methods Patients referred to coronary CTA with a HR >65 beats/min despite oral metoprolol premedication were enrolled in the study. We studied 412 patients (211 male; mean age, 57 ± 12 years). Two hundred four patients received intravenous esmolol, and 208 received intravenous metoprolol with a stepwise bolus administration protocol. HR and blood pressure were recorded at arrival, before, during, immediately after, and 30 minutes after the coronary CTA scan. Results Mean HRs of the esmolol and metoprolol groups were similar at arrival (78 ± 13 beats/min vs 77 ± 12 beats/min; P = .65) and before scan (68 ± 7 beats/min vs 69 ± 7 beats/min; P = .60). However, HR during scan was lower in the esmolol group vs the metoprolol group (58 ± 6 beats/min vs 61 ± 7 beats/min; P < .0001), whereas HRs immediately and 30 minutes after the scan were higher in the esmolol group vs the metoprolol group (68 ± 7 beats/min vs 66 ± 7 beats/min; P = .01 and 65 ± 8 beats/min vs 63 ± 8 beats/min; P < .0001; respectively). HR ≤65 beats/min was reached in 182 of 204 patients (89%) who received intravenous esmolol vs 162 of 208 of the patients (78%) who received intravenous metoprolol ( P < .05). Of note, hypotension (systolic BP <100 mm Hg) was observed right after the scan in 19 patients (9.3%) in the esmolol group and in 8 patients (3.8%) in the metoprolol group ( P < .05), whereas only 5 patients (2.5%) had hypotension 30 minutes after the scan in the esmolol group compared to 8 patients (3.8%) in the metoprolol group ( P = .418). Conclusion Intravenous esmolol with a stepwise bolus administration protocol is at least as efficacious as the standard of care intravenous metoprolol for HR control in patients who undergo coronary CTA. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivo É óbvia a importância de minimizar as respostas simpatoadrenérgicas exageradas e o intervalo QT e a dispersão do intervalo QT que podem ocorrer por causa de laringoscopia e intubação traqueal durante a indução da anestesia em pacientes hipertensos. Esmolol diminui a resposta hemodinâmica à laringoscopia e à intubação. Porém, o efeito de esmolol sobre a redução do intervalo QT prolongado e a dispersão do intervalo QT induzida pela laringoscopia e intubação é controverso. Pesquisamos o efeito de esmolol sobre a hemodinâmica e o intervalo QT corrigido e as alterações da dispersão do intervalo QT observadas durante a indução da anestesia em pacientes hipertensos que receberam inibidores da enzima conversora de angiotensina (IECA). Métodos Foram incluídos no estudo 60 pacientes, estado físico ASA I ‐ II , com hipertensão arterial essencial e que receberam IECA. O grupo esmolol recebeu uma dose em bolus de 500 mcg kg −1 , seguida por infusão contínua de 100 mcg kg −1 min −1 até o quarto minuto após a intubação. O grupo controle recebeu solução salina a 0,9%, semelhantemente ao grupo esmolol. Os valores da pressão arterial média e da frequência cardíaca e os registros do eletrocardiograma foram obtidos durante a fase inicial pré‐anestesia, cinco minutos após a administração de esmolol e solução salina, três minutos após a indução e 30 segundos, dois minutos e quatro minutos após a intubação. Resultados O intervalo QT corrigido foi menor no grupo esmolol (p = 0,012), o intervalo de dispersão do intervalo QT corrigido foi maior no grupo controle (p = 0,034) e a frequência cardíaca média foi maior no grupo controle (p = 0,022) 30 segundos após a intubação. O risco da frequência de arritmia foi maior no grupo controle no quarto minuto após a intubação (p = 0,038). Conclusão Descobrimos que a intubação traqueal prolonga o intervalo e a dispersão do intervalo QT corrigido e aumenta a frequência cardíaca durante a indução da anestesia com propofol em pacientes hipertensos que receberam IECA. Esses efeitos foram prevenidos com esmolol ( bolus de 500 mcg kg −1 , seguido de 100 mcg kg −1 min −1 de infusão). Durante a indução, a pressão tende a diminuir com esmolol. Portanto, cuidados são necessários. Background and objectives The importance of minimizing the exaggerated sympatho‐adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected‐QT interval and corrected‐QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors. Methods 60 ASA I – II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500 mcg/kg followed by a 100 mcg/kg/min infusion which continued until the 4 th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5 min after esmolol and saline administration, 3 min after the induction and 30 s, 2 min and 4 min after intubation. Results The corrected‐QT interval was shorter in the esmolol group ( p = 0.012), the corrected‐QT interval dispersion interval was longer in the control group ( p = 0.034) and the mean heart rate was higher in the control group ( p = 0.022) 30 s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4‐min period following intubation ( p = 0.038). Conclusion Endotracheal intubation was found to prolong corrected‐QT interval and corrected‐QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500 mcg/kg bolus, followed by 100 mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed. [ABSTRACT FROM AUTHOR]

Resumo Objetivo Estudo prospectivo, randômico e duplo‐cego planejado para identificar a dose ideal de perfusão de esmolol para suprimir o aumento dos valores do BIS e os movimentos e respostas hemodinâmicas à intubação traqueal. Materiais e Métodos 120 pacientes foram randomicamente alocados um dos três grupos, usando o método duplo‐cego. Propofol (2,5 mg kg −1 ) foi administrado para indução da anestesia. Após a perda da consciência e antes da administração de rocurônio (0,6 mg kg −1 ), um torniquete foi aplicado a um braço e insuflado a 50 mm Hg acima da pressão sistólica. Os pacientes foram divididos em três grupos; uma dose de 1 mg kg −1 h −1 de esmolol foi administrada como carga e perfusão de 50 μg kg −1 min −1 de esmolol foi iniciada no Grupo ES50, 150 μg kg −1 min −1 no Grupo Es150 e 250 μg kg −1 min −1 no Grupo ES250. Cinco minutos após o início da perfusão, a traqueia foi intubada; o total de movimentos no primeiro minuto após a intubação orotraqueal foi registrado. Resultados A incidência da resposta de movimentos e os valores máximos de ΔBIS foram comparáveis nos grupos ES250 e Es150, mas esses valores foram significativamente mais elevados no Grupo ES50 que nos outros dois grupos. Nos três grupos, os valores de frequência cardíaca e pressão arterial média foram significativamente maiores no primeiro minuto pós‐intubação, comparados aos valores pré‐intubação ( p < 0,05). Não houve diferença significativa entre os grupos em relação à frequência cardíaca e pressão arterial média durante o período de estudo. Conclusão Na prática clínica, acreditamos que após uma dose com carga de 1 mg kg −1 , uma dose de 150 μg kg −1 min −1 de esmolol IV é suficiente para suprimir a resposta à intubação traqueal sem aumentar os efeitos colaterais. Objective A prospective, randomized and double‐blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation. Materials and methods 120 patients were randomly allocated to one of three groups in a double‐blind fashion. 2.5 mg kg −1 propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6 mg kg −1 rocuronium, a tourniquet was applied to one arm and inflated to 50 mm Hg greater than systolic pressure. The patients were divided into 3 groups; 1 mg kg −1 h −1 esmolol was given as the loading dose and in Group Es50 50 μg kg −1 min −1 , in Group Es150 150 μg kg −1 min −1 , and in Group Es250 250 μg kg −1 min −1 esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded. Results Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1 st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation ( p < 0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure. Conclusion In clinical practise we believe that after 1 mg kg −1 loading dose, 150 μg kg −1 min −1 iv esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos Laringoscopia e intubação podem causar resposta hemodinâmica. Vários medicamentos podem ser usados para controlar essa resposta. Neste estudo, nosso objetivo foi comparar os efeitos de dexmedetomidina, fentanil e esmolol sobre a resposta hemodinâmica. Métodos Foram incluídos no estudo prospectivo, randômico e duplo‐cego 90 pacientes programados para cirurgias eletivas, com intubação endotraqueal, estado físico ASA I‐II, entre 21 e 65 anos. Pressões arteriais médias, sistólicas, diastólicas e frequências cardíacas foram medidas ao darem entrada na sala de operações e registradas como valores basais. Os pacientes foram randomizados em três grupos: Grupo I (n = 30) recebeu 1 μg/kg de dexmedetomidina com infusão em 10 min; Grupo II (n = 30) recebeu 2 μg/kg de fentanil; Grupo III (n = 30) recebeu 2 mg/kg de esmolol 2 min antes da indução. Os pacientes foram intubados em 3 min. As pressões médias, sistólicas e diastólicas e as frequências cardíacas foram medidas antes da indução, antes da intubação e nos minutos 1, 3, 5 e 10 após a intubação. Resultados Quando os níveis basais foram comparados entre os grupos, verificou‐se que nos minutos 5 e 10 pós‐intubação as frequências cardíacas no Grupo I e as pressões arteriais médias, sistólicas e diastólicas no Grupo III estavam mais baixas do que em outros tempos mensurados (p <0,05 ). Conclusões Dexmedetomidina foi superior na prevenção de taquicardia. Esmolol preveniu o aumento das pressões arteriais médias, sistólicas e diastólicas após a intubação. Concluímos que estudos adicionais são necessários para descobrir uma estratégia que previna tanto o aumento da pressão arterial sistêmica quanto da frequência cardíaca. Background and objectives Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Method Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double‐blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I ( n = 30) received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II ( n = 30) received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation. Results When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements ( p < 0.05). Conclusions Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos Esmolol é conhecido por não ter atividade analgésica e propriedades anestésicas; porém, pode potenciar a redução da necessidade de anestésicos e reduzir o uso de analgésicos no pós‐operatório. O objetivo deste estudo foi avaliar o efeito da infusão de esmolol por via intravenosa sobre o consumo de analgésico durante os períodos intraoperatório e pós‐operatório, bem como seu efeito sobre a profundidade da anestesia. Métodos Este estudo randômico, controlado e duplo‐cego foi conduzido em um hospital terciário entre março e junho de 2010. Foram randomicamente divididos em dois grupos 60 pacientes programados para serem submetidos à septorrinoplastia. História de alergia aos medicamentos usados no estudo, isquemia cardíaca, bloqueio cardíaco, asma brônquica, insuficiência hepática ou renal, obesidade e história de uso crônico de analgésicos ou β‐bloqueadores foram os critérios de exclusão. Trinta pacientes receberam esmolol e remifentanil (grupo esmolol) e 30 receberam soro fisiológico e remifentanil (grupo controle) via perfusão intravenosa. Pressão arterial média, frequência cardíaca e valores do índice bispectral foram registrados a cada 10 minutos. Consumo total de remifentanil, escores da escala visual analógica, tempo para a primeira analgesia e consumo total de morfina no pós‐operatório foram registrados. Resultados O consumo total de remifentanil, os escores da escala visual analógica nos minutos 0, 20 e 60, o consumo total de morfina, o tempo para a primeira analgesia e o número de pacientes que precisaram de morfina intravenosa foram menores no grupo esmolol. Conclusões Esmolol em infusão intravenosa reduziu o consumo de analgésicos tanto no intraoperatório quanto no pós‐operatório, reduziu os escores da escala analógica visual no pós‐operatório imediato e prolongou o tempo para a primeira analgesia; contudo, não influenciou a profundidade da anestesia. Background and objectives Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia. Method This randomized‐controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β‐blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10 min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded. Results The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group. Conclusions Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivo o objetivo deste estudo prospectivo, randômico e duplo‐cego foi investigar os efeitos do uso diferente de esmolol na resposta hemodinâmica à laringoscopia, intubação orotraqueal e esternotomia em cirurgia de revascularização coronária. Métodos após obter a aprovação do Comitê de Ética local e consentimento informado assinado pelos pacientes, 45 pacientes foram randomicamente divididos em três grupos. O Grupo I (infusão) recebeu 0,5 mg/kg/min de esmolol em infusão a partir de 10 min antes da intubação até 5 minutos após a esternotomia; o Brupo B ( bolus ) recebeu 1,5 mg/kg de esmolol em bolus IV a partir de 2 min antes da intubação e esternotomia; o grupo C (controle) recebeu NaCl a 0,9%. Todos os parâmetros demográficos foram registados. Os valores de frequência cardíaca e pressão arterial foram registrados desde antes da infusão até a indução da anestesia a cada minuto, durante a intubação endotraqueal, a cada minuto durante 10 min após a intubação endotraqueal e antes, durante e após a esternotomia no primeiro e quinto minutos. Resultados enquanto a área sob a curva (ASC) (SAP × tempo) foi maior nos grupos B e C que no Grupo I, a ASC (SAP × T int e T st ) e ASC (SAP × T2) foram maiores nos grupos B e C que no Grupo I (p < 0,05). Além disso, a ASC (FC × T st )) foi menor no Grupo B que no Grupo C, mas não houve diferença significante entre os grupos B e I. Conclusão este estudo destaca que a administração de esmolol em infusão é mais eficaz que em bolus para controlar a pressão arterial sistólica durante a intubação endotraqueal e esternotomia em CRC. Background and objective The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. Methods After approval of local ethics committee and patients’ written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, 0.5 mg/kg/min esmolol infusion, in Bolus Group; 2 min before intubation and sternotomy 1.5 mg/kg esmolol IV bolus and in Control Group; %0.9 NaCl was administered. All demographic parameters were recorded. Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute, during endotracheal intubation, every minute for 10 minutes after endotracheal intubation and before, during and after sternotomy at first and fifth minutes. Results While area under curve (AUC) (SAP × time) was being found more in Group B and C than Group I, AUC (SAP × Tint and Tst) and AUC (SAP × T2) was found more in Group B and C than Group I (p < 0.05). Moreover AUC (HR × Tst) was found less in Group B than Group C but no significant difference was found between Group B and Group I. Conclusion This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery. [ABSTRACT FROM AUTHOR]

Hypertension has been reported during emergence from anesthesia to be >90% in neurosurgical patients. We examined the effects of dexmedetomidine, remifentanil, and esmolol infusion on recovery profiles and cardiovascular responses of patients during the emergency period after a craniotomy. ASA I to III physical status patients, who were undergoing intracranial surgery for either vascular or space-occupying lesions, were eligible if aged between 17 and 65 years. Anesthesia was induced using propofol and dexmedetomidine and maintained using sevoflurane and dexmedetomidine infusion. Patients were randomly allocated in 3 groups. Dexmedetomidine infusion was continued until the initiation of skin closure in group D. Dexmedetomidine infusion was discontinued in other groups after placing the bone graft. Thereafter, remifentanil infusion (0.25 µg/kg/min) or esmolol infusion (0.25 mg/kg/min) were started in the other groups (group R or E) until the initiation of skin closure. Extubation time, recovery time, incidence of coughing during extubation, and hemodynamic variables during the emergence phase were recorded. During the emergence phase, the systolic and mean arterial blood pressures and heart rates were similar compared with baseline values in all study groups. The median extubation time was similar in the dexmedetomidine (4.9 min), remifentanil (3.9 min), and esmolol groups (2.7 min). The incidence of cough was similar in the dexmedetomidine group compared with the remifentanil or esmolol groups. Time to eye opening, time to orientation, and response to verbal command were longer in the dexmedetomidine group compared with the remifentanil group. We concluded that remifentanil, dexmedetomidine, and esmolol infusion can be used to control blood pressure during emergence from anesthesia after a craniotomy. [ABSTRACT FROM AUTHOR]

Objectives: Veno-venous extracorporeal membrane oxygenation (ECMO) is a well-established therapy in patients affected by respiratory failure and unresponsive to conventional therapy. Despite technical innovations, some limitations still exist, the most important one being refractory hypoxemia. This problem is linked partially to the mixture between patients'' blood and ECMO fully oxygenated blood. In the present work, the reduction of cardiac output was proposed for the treatment of refractory hypoxemia in patients with high-flow ECMO and high endogenous cardiac output. Design: An observational study. Setting: A university hospital. Participants: Three consecutive patients suffering from persisting severe hypoxemia despite high-flow ECMO and with concomitant high cardiac output (>7 L/min). Intervention: A bolus dose of 500 μg/kg and a continuous infusion of esmolol was used and titrated to an SpO2 >92%. Measurements and Main Results: Esmolol administration was safe and highly beneficial in terms of peripheral oxygenation. PaO2 increased from 54 to 90 mmHg, from 50 to 94 mmHg, and from 49 to 66 mmHg during the first 12 hours of esmolol treatment in the 3 patients. Conclusions: In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. Methods: A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Results: Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p < 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Conclusion: Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This article describes the rationale and design of the DECREASE-XIII trial, which aims to evaluate the potential of esmolol infusion, an ultra-short-acting beta-blocker, during surgery as an add-on to chronic low-dose beta-blocker therapy to maintain perioperative haemodynamic stability during major vascular surgery. Design: A double-blind, placebo-controlled, randomised trial. Materials & methods: A total of 260 vascular surgery patients will be randomised to esmolol or placebo as an add-on to standard medical care, including chronic low-dose beta-blockers. Esmolol is titrated to maintain a heart rate within a target window of 60–80 beats per minute for 24 h from the induction of anaesthesia. Heart rate and ischaemia are assessed by continuous 12-lead electrocardiographic monitoring for 72 h, starting 1 day prior to surgery. The primary outcome measure is duration of heart rate outside the target window during infusion of the study drug. Secondary outcome measures will be the efficacy parameters of occurrence of cardiac ischaemia, troponin T release, myocardial infarction and cardiac death within 30 days after surgery and safety parameters such as the occurrence of stroke and hypotension. Conclusions: This study will provide data on the efficacy of esmolol titration in chronic beta-blocker users for tight heart-rate control and reduction of ischaemia in patients undergoing vascular surgery as well as data on safety parameters. [Copyright &y& Elsevier]

Objective: Literature increasingly has suggested how β-blockers could be associated with reductions of mortality and morbidity in noncardiac surgery. Recently, the POISE trial showed that β-blockers could be harmful in the perioperative period. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in noncardiac surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 1765 patients from 32 randomized trials. Interventions: None. Measurements and Main Results: Three investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of esmolol versus placebo, other drugs, or standard of care in noncardiac surgery. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no data on clinical outcomes. The use of esmolol was associated with a significant reduction of myocardial ischemia episodes (5/283 [1.76%] in the esmolol group v 16/265 [6.03%] in the control arm, odds ratio [OR] = 0.16 [0.05-0.54], p = 0.003). The authors did not observe significant differences regarding episodes of arrhythmias (8/236 [3.38%] v 22/309 [7.11%], OR = 0.52 [0.23-1.18], p = 0.12) and in the incidence of myocardial infarction (0/148 [0%] v 1/169 [0.59%], OR = 0.23 [0.01-6.09], p = 0.38). Esmolol-treated patients did not experience more episodes of hypotension (17/384 [4.42%] v 38/439 [8.65%], OR = 0.41 [0.22-0.79], p = 0.17) and bradycardia (25/342 [7.30%] v 17/406 [4.18%], OR = 1.42 [0.74-2.74], p = 0.42). Conclusions: Esmolol seemed to reduce the incidence of myocardial ischemia in noncardiac surgery without increasing the episodes of hypotension and bradycardia. Large randomized trials are necessary to confirm these promising results. [Copyright &y& Elsevier]

Objective: β-Blockers were associated with a reduction of mortality and morbidity in noncardiac surgery until recently when the POISE trial showed that β-blockers could be harmful in the perioperative period because of hypotension and bradycardia. Esmolol is an ultra–short-acting β-blocker mostly used in emergency and high-risk patients. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in cardiac surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 778 patients from 20 randomized trials. Interventions: None. Measurements and Main Result: Three investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of esmolol versus other drugs, placebo, or standard of care in cardiac surgery. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no data on clinical outcomes. The use of esmolol was associated with a significant reduction of myocardial ischemia episodes (15/122 [12.2%] in the esmolol group v 36/140 [25.7%] in the control arm, odds ratio [OR] =0.42 [0.23-0.79], p = 0.007) and development of arrhythmias after cardiopulmonary bypass (15/65 [23.07%] v 23/64 [35.9%], OR = 0.42 [0.18-1.01], p = 0.05). The authors did not find a reduction in the use of inotropic drugs in esmolol-treated patients (29/153 [18.9%] v 48/146 [32.8%], OR = 0.43 [0.16-1.10], p = 0.08). Esmolol-treated patients had more episodes of bradycardia (19/129 [14.72%] v 3/133 [2.25%], OR = 5.49 [2.21-13.62], p = 0.0002) and hypotension (28/113 [24.77%] v 14/119 [11.76%], OR = 2.73 [0.83-9.04], p = 0.10). Conclusions: Esmolol reduces the incidence of myocardial ischemia and arrhythmias in cardiac surgery. An increase in bradycardia was noted as well. [Copyright &y& Elsevier]

Summary: Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery. [Copyright &y& Elsevier]

Objective: The purpose of this study was to compare the effectiveness of intravenous (IV) nicardipine versus esmolol in controlling heart rate (HR) and blood pressure (BP) responses to emergence and extubation. Design: Prospective, randomized, double blind. Setting: University hospital, single institution. Participants: Twenty-two American Society of Anesthesiologists physical class 1 to 3 adult inpatients scheduled for general anesthesia. Interventions: General endotracheal anesthesia with oxygen/isoflurane and muscle relaxation. At end of surgery, with at least 2 twitches by nerve stimulator and end-tidal isoflurane <0.4%, muscle relaxant reversal was accomplished with neostigmine and glycopyrrolate. Two minutes postreversal, the IV study drug nicardipine, 0.03 mg/kg, or esmolol, 1.5 mg/kg, was administered. HR and BP were measured every minute up to 10 minutes and at minute 15 postreversal. Measurements and Main Results: There were no significant differences between groups in age, weight, gender, American Society of Anesthesiologists physical class or preoperative hemodynamics (HR, BP, mean arterial pressure [MAP]). Compared with nicardipine, 0.03 mg/kg IV, esmolol, 1.5 mg/kg IV, significantly (p < 0.05) attenuated HR more than nicardipine for the 15-minute time period poststudy drug. Compared with esmolol, nicardipine was significantly (p < 0.05) more effective in controlling MAP and systolic BP for the 1- to 3-minute and diastolic BP for the 1- to 2-minute time periods poststudy drug. There were no episodes of hypotension or adverse events. Conclusions: Although esmolol, 1.5 mg/kg, IV was more effective than nicardipine, 0.03 mg/kg, IV for attenuating the HR response to extubation, nicardipine was more effective in controlling the BP response. [Copyright &y& Elsevier]

Objective: Critical myocardial oxygen imbalance as indicated by elevated interstitial lactate levels may occur in cases of rapidly elevated end-diastolic myocardial wall tension during elevated myocardial contractility in the intact myocardium. Simultaneous administration of β-adrenergic receptor agonist and antagonist reliably allows for investigating the myocardial response. Design: Experimental using an in vivo animal model. Setting: Research institution. Participants: Animal model. Interventions: Not applicable. Measurements and Results: Fifteen minipigs were investigated in an open-chest model. After a midline sternotomy, a thin dialysis tube was implanted into the LV midmyocardium. Extracellular lactate in perfusate was analyzed every 5 minutes. End-systolic time-varying elastance and end-diastolic wall tension were measured. After a stable period, dobutamine (10 μg/kg/min) was administered to 8 animals. After 20 minutes, esmolol (0.5-mg/kg bolus, repetitively) was added until heart rate decreased to <100 beats/min. For 20 minutes, esmolol was infused at a rate of 3 mg/kg/h, and then dobutamine alone was continued for 10 minutes. With dobutamine, the lactate level did not change, but wall tension decreased and contractility increased. Simultaneous esmolol initially (in the first 10 minutes) increased lactate, whereas LV end-diastolic wall tension and contractility both increased; but after 10 minutes, lactate and contractility decreased significantly. Lactate again increased within 10 minutes after stopping esmolol. A group of 7 animals received esmolol for 20 minutes and showed no changes in lactate; myocardial wall tension increased and contractility decreased. Conclusion: Results suggest that oxygen demand/supply is balanced until both end-diastolic wall tension and myocardial contractility are elevated to critical levels. [Copyright &y& Elsevier]