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Objective: To investigate the effects of esmolol hydrochloride combine with dexmedetomidine on stress response and helper T cell 1 (Th1) /Th2 cytokines in lung cancer patients. Methods: A total of 112 patients with lung cancer undergoing radical surgery who were admitted to Tianyou Hospital affiliated with Wuhan University of Science and Technology from June 2020 to March 2022were selected. The patients were divided into control group (n=56, conventional anesthesia combined with dexmedetomidine hydrochloride injection) and study group (n=56, control group combined with esmolol hydrochloride injection) according to the random number table method. Awakening quality, lung function indicators, stress response indicators, Th1/Th2 cytokines, and postoperative pulmonary complications between the two groups were compared. Results: The respiratory recovery time, directional recovery time, and extubation time of the study group were shorter than those of the control group (P＜0.05) . The incidence of postoperative pulmonary complications in the study group was lower than that in the control group (P＜0.05) . The postoperative dynamic lung compliance (Cdyn) of the study group after operation was higher than that of the control group, while platform pressure (Pplat) and peak airway pressure (Ppeak) were lower than those of the control group (P＜0.05) . The postoperative cortisol (Cor), norepinephrine (NE), and epinephrine (E) levels in the study group after operation were lower than those in the control group (P＜0.05) . Tumor Necrosis Factor-α (TNF-α), interleukin-2 (IL-2) of the study group after operation were lower than those of the control group (P＜0.05), Interleukin-10 (IL-10), transforming growth factor-β1 (TGF-β1) of the study group after operation were higher than those of the control group (P＜0.05) . Conclusion: Esmolol hydrochloride combine with dexmedetomidine has a good anesthetic effect in radical lung cancer surgery, which can effectively reduce intraoperative stress response, regulate immune function, and protect lung function. It can also reduce the incidence of postoperative pulmonary complications. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of esmolol, a short-acting, highly selective β-blocker, on cardiomyocyte apoptosis in septic rats and its possible mechanism. Methods A total of 63 male Wistar rats were randomly divided into sham operation group (Sham group), sepsis group (CLP group), and esmolol group (ES group). Each group was further divided into 6-, 12-, and 24-hour subgroups. The rats of the Sham group were given sham surgery only, and those of the CLP and ES groups underwent cecal ligation and puncture (CLP) to establish sepsis model. The Sham group and the CLP group were continuously infused with 0.9% sodium chloride solution at a speed of 1 mL/h by micropump for 6 h, while the ES group was continuously infused with 15 mg/kg·h esmolol diluted solution at 1 mL/h for 6 h. Then the rats were sacrificed at 6, 12 and 24 h after successful modeling, and the heart specimens were collected. Serum TNF-α and BNP levels were measured by ELISA. Water soluble tetrazolium (WST-1) method was used to detect SOD activity, and spectrophotometry to determine MDA content in myocardial tissue. The expression levels of Caspase-3, Bcl-2, Bax and other proteins in myocardial tissue were detected by Western blotting. Transmission electron microscopy was performed to observe the morphology and structure of myocardial mitochondria. Results Compared with the levels at the same time points in Sham group, the serum TNF-α and BNP levels, MDA content, and expression levels of apoptotic proteins such as Caspase-3 and Bax were significantly increased in the CLP and ES groups (P < 0.05). Except the level of BNP in ES24h group was not significantly different than that in CLP24h group (P>0.05), ES group had obviously decreased serum TNF-α and BNP levels, MDA content, and expression levels of Caspase-3 and Bax when compared with those in the CLP group at same time points (P < 0.05). The SOD activity and Bcl-2 level were remarkably higher in the CLP and ES groups at the same time points (P < 0.05), and the activity and levels were increased in the ES group than the CLP group at all time points (P < 0.05). Under a transmission electron microscope, myocardial fibers and mitochondria were almost intact in the Sham group at all time points; the damages were the most severe in the CLP group, and the severity was deteriorated gradually with time elapse, while the conditions became alleviated in the ES group at each time point. Conclusion Esmolol partially improves cardiac function in septic rats by inhibiting cardiomyocyte apoptosis. The mechanism may be due to its inhibition in apoptosis initiation factor TNF-α and regulation in the expression of apoptosis-related proteins such as Bcl-2, Bax, and Caspase-3, and reduction of the oxidative stress response as well. It mediates both the accompanying process of apoptosis and an important initiator of apoptosis, and protects the mitochondrial structure of target organelles damaged by apoptosis and oxidative stress.

Objective To explore the effect of dexmedetomidine-esmolol combination therapy on the lactic acid contents, the levels of S100B, intracranial pressure (ICP) and outcome in patients with severe traumatic brain injury undergoing decompression craniectomy. Methods Sixty patients with severe craniocerebral trauma who underwent unilateral craniocerebral decompression from January 2015 to December 2018 were selected as the observation objects. According to the application of postoperative sedative drugs, the patients were divided into two groups: the co-treatment group of esmolol combined with dexmedetomidine (the co-treatment group, n=30) and the control group of dexmedetomidine alone (the control group, n=30). Cerebrospinal fluid (CSF) was collected before treatment and on 1, 3 and 7 d after treatment. The lactic acid contents and the levels of S100B of the CSF were detected. Glasgow coma scale (GCS) score and National Institute of Health stroke scale (NIHSS) score were compared 14 d after treatment between the two groups. Glasgow outcome scale (GOS) score were used to evaluate long-term outcome on 6 months after treatment. Results After treatment, CSF lactic acid content and S100B level decreased significantly at 1, 3 and 7 d after treatment in co-treatment group than those of the control group (P＜0.05). The GCS score and NIHSS score were significantly higher at 14 d after treatment in the cotreatment group than those in the control group (P＜0.01). There was no significant difference in the GOS score within 6- month follow up between the two groups of patients (P＞0.05). Conclusion Dexmedetomidine-esmolol combination therapy can reduce the levels of CSF lactic acid and S100B in patients with severe traumatic brain injury undergoing decompression craniectomy and improve the short-term outcome, but it has no significant effect on the long-term prognosis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the esmolol on myocardial protection in elderly patients with coronary heart disease undergoing gastric cancer operation during perioperative period. METHODS: Totally 122 elderly patients with coronary heart disease undergoing gastric cancer operation admitted into the Second Affiliated Hospital of Hainan Medical University from Sept. 2016 to Dec. 2018 were extracted to he divided into the observation group and the control group via the random number table, with 61 cases in each group. Patients in the observation group were treated with esmolol, while the control group was given 0.9% sodium chloride injection. The left heart function indicators [left ventricular ejection fraction (LVEF), cardiac output (CO) and cardiac index (CI)] levels, serum cardiac troponin I (cTn I), creatine kinase isoenzyme (CK-MB) and cardiac adverse drug events of two groups were observed, and differences of mean arterial pressure (MAP), heart rate (HR) and heart rate systolic pressure product (RPP) before induction of anesthesia (T0), after tracheal intubation (T1), after pneumoperitoneum (T2), at the end of surgery (T3), at extubation (T4), and 30 min after extubation (T5) were compared. RESULTS: At 24 h after operation, the LVEF, CO and CI levels in two groups were significantly higher than those before anesthesia induction, and the observation group were significantly higher than the control group, with statistically significant differences (P< 0.05). At T1, T2, T3 and T4, the HR level of the observation group was significantly lower than that of the control group; at T1, T2, T3 and T4, the MAP and BPP levels in the observation group were significantly lower than those in the control group, and the difference was statistically significant (P<0.05). At 6, 12 and 24 h after operation, the levels of serum cTn I and CK-MB in the observation group were significantly lower than those in the control group (P< 0.05). The incidences of angina pectoris, arrhythmia, myocardial infarction and myocardial ischemia in the observation group were significantly lower than those in the control group (P< 0.05). CONCLUSIONS: Esmolol on myocardial protection in treatment elderly patients with coronary heart disease undergoing gastric cancer operation during perioperative period can effectively improve the left heart function, stabilize the hemodynamics, decrease the serum cTn I and CK-MB levels, and protect patients’ myocardial function, with higher safety. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of esmolol and dexmedetomidine for elective neurosurgical patients in attenuating their sympathomimetic response to laryngoscopy and intubation. Methods: 90 patients who intended to get elective neurosurgery in our hospital were selected and randomly allocated to three groups, with 30 cases in each group. The patients in the control group were given the intravenous injection of 20 m L 0.9% saline, and the patients in dexmedetomidine group were given intravenous injection of 1 μg/kg dexmedetomidine diluted with 0.9% saline to 20 m L, and the patients in the esmolol group were given intravenous injection of 1.5 mg/kg esmolol diluted with 0.9% saline to 20 m L. All patients got 2 min induction of anesthesia, and had the drugs injected within 10 min. Then the heart rate(HR), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, right after drug administration, right after induction and at 1, 2, 3, 5, 10, and 15 min after orotracheal intubation. Results: Compared with the control group, there was no statistically significant difference in HR and blood pressure after intubation at any time intervals in dexmedetomidine group. While in esmolol group, there was a statistical significant increase in blood pressure at 1, 2, and 3 min and in HR at 5 min after intubation. Conclusion: Dexmedetomidine is more effective than esmolol in attenuating the hemodynamic response to laryngoscopy and intubation for elective neurosurgical patients. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effects of different doses of esmolol-sufentanil on stress responses during wake-up test for scoliosis surgery patients. Methods Sixty patients，aged 18-64 yr， scheduled for scoliosis surgery， were randomly divided into 4 groups （n＝15 each） : saline control group （group C），and 3 different doses of esmolol groups （groups E1，E2 and E3） . Drugs and methods of anesthesia induction and maintenance were the same in four groups. In E1-E3 groups，esmolol was injected iv 0.5， 0.75 and 1.0 mg/kg at 5 min after wake-up test，while the same volume of normal saline was given in group C. During intraoperative wake-up test， sufentanil was maintained with target-controlled effect-site concentration at 0.1 ng/mL of four groups. The wake-up test time were recorded: 30 min prior to wake-up test （T0）， 5 min after wake-up test （T1） and 10 min after wake-up test （T2） . Blood samples were taken for determination of plasma concentrations of epinephrine （E） . Cardiovascular events during the wake-up test were recorded. Results Compared with group C， the incidences of hypertension and tachycardia were significantly lower in E1-E3 groups， and the plasma concentrations of E were decreased in E2 and E3 groups. The incidences of hypertension and tachycardia were lower in group E3 than in group E1. The plasma concentrations of E were decreased in group E2 than in group E1 and the same in group E3than in group E2 （ < 0.05） . Conclusion Esmolol-sufentanil can reduce the stress response during wake-up test in patients undergoing scoliosis surgery and in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Objective To observe the influence of intravenous esmolol on blood potassium level and hemodynamics in the patients with general anesthesia surgery for increasing its medication safety. Methods Totally 100 cases of laparoscopic cholecystectomy in our hospital from September 2014 to March 2015, ASA gradeⅠ~Ⅱ, were selected and divided into the research group and the control group according to the random number table method, 50 cases in each group. The research group was intravenously injected by esmolol 0.75 mg/kg at 2 min before intubation, while the control group by the same amount of normal saline. The arterial blood potassium, heart rate (HR), mean arterial pressure (MBR), blood lactic acid and pH value were detected before anesthetic induction and medication (T0), at 5 min (T1), 15 min (T2), 30 min (T3) min after medication. Results The blood potassium level at T1, T2 in the research group was significantly increased compared with that at T0 and T3, the difference was statistically significant (P<0.05); the blood potassium level at T1, T2 in the control group had no obvious change compared with that at T0 and T3, the difference was not statistically significant (P>0.05); the blood potassium level at T1 and T2 in the research group were higher than that in the control group, the difference had statistical significance(P<0.05); HR and MBP at each time point in the research group had no obvious change, while which at T1 and T2 in the control group were increased, showing statistical difference compared with the research group (P<0.05); MBP,HR and arterial blood potassium level in the two groups had no statistical differ-ence between at T3 and T0(P>0.05), moreover the difference between the groups had no statistical significance (P>0.05); blood lactic acid level and pH value at each time point in the two groups had no obvious change, the difference was not statistically significant (P>0.05); 18 cases of tachycardia in the control group occurred after intubation, but no adverse cardiovascular events occurred in the research group. Conclusion Intravenous esmolol 0.75 mg/kg before tracheal intubation can inhibit excessive cardiovascular stress response, but could lead to blood potassium level transient elevation, so its application should pay attention to that increased blood potassium level could cause the adverse reaction for ensuring the patient′s safety. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the rational dosage and clinical effects of esmolol in anesthesia and resuscitation. METHODS: 92 cases receiving painless gastroscopy admitted into our hospital from Mar.2013 to Mar.2015 were selected to be divided into group A, group B and group C via the random number table. 30 cases in group A were treated with 0.5 mg/kg esmolol, 32 cases in group B were given 1.0 mg/kg esmolol, and another 30 cases in group C received 0.9% sodium chloride injection. The heart rate (HR), changes of mean arterial pressure (MAP), the consumption amount of narcotics, length of stay in hospital for observation, awake time of anesthesia and adverse reactions at before administration (T0), after anesthesia induction (T1), gastroscope over the glottis (T2) and gastroscope over the duodenum (T3) were observed in three groups.RESULTS: The levels of HR and MAP of group C at T1,T2,T3 were significantly higher than that of group A and group B, and group A were higher than group B, with statistically significant difference (P<0.05). The length of stay in hospital for observation and awake time of anesthesia in group C were significantly higher than that in group A and group B [(50.2 ±6.4) min VS (30.3 ±6.2) min VS (30.3 ±6.0) min,(5.2 ±1.1 ) min VS (2.5 ±1.1) min VS (2.4 ±1.2 ) min ], the difference was significant (P<0.05). The dosage of propofol and remifentanil in group C were also significantly higher than that in group A and group B [(2.2 ± 0.3) μg/kg VS (2.0 ±0.2) μg/kg VS (3.4 ±0.4) μg/kg, (0.36 ±0.05) mg/kg VS (0.35 ±0.04) mg/kg VS (0.42 ±0.08) mg/kg], with statistically significant difference (P<0.05). There were no obvious adverse reactions in three group of patients. CONCLUSIONS: Different doses of esmolol in painless gastroscopy sedation anesthesia and anesthesia resuscitation has a significant, safe and effective efficacy, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of esmolol in septic shock patients with tachycardia. Methods: A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group ( n= 50) and control group ( n= 50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn't achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups. Results: The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ(2)=0.529, P= 0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR= 1.568, 95 %CI : 1.039-1.238, P= 0.027), primary APACHEⅡ ( OR= 1.134, 95 %CI : 1.026-1.239, P= 0.005), integral heart rate (per 10 bpm, OR= 2.207, 95 %CI : 1.400-3.479, P= 0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups ( P> 0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P> 0.05). Conclusion: Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.