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Background: Perioperative period is characterized by stressful and rapidly changing physiological responses. During this period, many factors and stimuli lead to the activation of the sympathetic nervous system, causing various hemodynamic changes, mainly tachycardia. Studies showed that stress and hemodynamic changes occurring during this period are associated with increased cardiac damage, morbidity and mortality. Beta blockers can prevent these negative results due to stress, thanks to their sympatholytic effects. Esmolol hydrochloride is a selective β-1 receptor blocker with a rapid onset and very short duration of action. Our aim in this study is to investigate the effect of perioperative esmolol use on perioperative hemodynamics, the amount of inhalation agent and narcotic consumed, and the amount of analgesic drug consumed postoperatively in patients undergoing non-cardiac operation and at moderate-high risk for the development of cardiac events. Materials and Methods: 40 patients undergoing elective grade 3-4 urology and general surgery operations under general anesthesia and have medium-high risk of perioperative cardiac event development according to the revised cardiac risk index and Mangano criteria were included in the study. Patients were randomized to esmolol (n=20) and control group (n=20). Esmolol group was loaded with esmolol 500 µg/kg/min for 1 minute intravenously (i.v.) and maintained as the heart rate to be <80/min., whereas 0.9% NaCl i.v. was given to the control group. Results: There was no significant difference between two groups in terms of age (P=0.910), gender (P=0.519), surgical grade (P=0.288), and ASA scores (P=0.218). However; heart rate (HR) and mean arterial pressure (MAP) decreased significantly after drug loading compared to basal value in esmolol group, whereas there was no significant change in control group. There was no difference between two groups in terms of sevoflurane consumption, but the frequency of additional fentanyl requirement (P=0.047) and the amount of consumed fentanyl (P=0.039) were significantly lower in esmolol group. In the postoperative period, it was detected that HR and MAP values were significantly lower in esmolol group than control group. However, there was no difference between two groups in terms of postoperative pain and morphine consumption. Conclusions: We demonstrated that use of esmolol provides an effective hemodynamic stabilization in the perioperative and postoperative period and reduces the amount of consumed narcotics perioperatively in patients undergoing noncardiac surgery with mediumhigh risk. However, we could not detect a significant effect of esmolol on the amount of consumed inhalation agent and postoperative analgesic use. [ABSTRACT FROM AUTHOR]

Introduction: During lower gastrointestinal surgery, the effects of general anaesthesia and combined general/epidural anaesthesia on cardiac risk, intraoperative hemodynamic parameters and cardiac enzymes were investigated. Material and Method: Thirty six patients were randomly assigned either to general anaesthesia (Group 1; n=20) or combined general/epidural anaesthesia (Group 2; n=16) groups. General anaesthesia included the usage of intravenous remifentanil,and rocuronium and inhalational sevoflurane. The lumbar epidural catheter was introduced before anaesthesia induction. After 10 mL of 0.25 % bupivacaine bolus dose, an infusion of 0.25 % bupivacaine at a dose of 4 ml/h continued for 24 hours were instituted. Heart rate, and arterial blood pressures were recorded intraoperatively every 10 minutes, 1 and 24 hours postoperatively. Cardiac risk is evaluated by 2007 AHA/ACC (American Heart Association/American College of Cardiology) and Modified Goldman risk indexes. Plasma cardiac enzyme levels were measured before operation, and 24 hours postoperatively. Results: Patients with mild and severe cardiac risks were found to be increased when 2007 AHA/ACC criteria were used rather than (10/36, % 28), modified Goldman index (3/36, % 8,3) (p=0.008). Five and fifteen minutes after induction, mean arterial blood pressures and heart rates were higher in group 1 in comparison to Group 2 whereas, there was no difference between groups at other time points (p<0.05). Cardiac enzyme levels were similar (p>0.05). Conclusion: Combined general/epidural anaesthesia showed better hemodynamic stability during intubation and extubation It hadn't any significant effect on cardiac enzyme levels. Mild or severe cardiac risk was identified better with the use of 2007 AHA/ACC cardiac risk evaluation rather than the modified Goldman index. [ABSTRACT FROM AUTHOR]