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A 4-year-old male neutered Boston Terrier was presented with status epilepticus. He was diagnosed with idiopathic epilepsy and hospitalized with supportive care. During hospitalization, the patient developed both supraventricular and ventricular arrhythmias as well as focal left ventricular dyskinesis. Cardiac troponin I was significantly increased, which was supportive of myocardial damage. Neurogenic stunned myocardium was suspected, and the patient was treated and responded to esmolol. Follow-up echocardiography demonstrated the resolution of the ventricular dyskinesia. This report describes the clinical presentation, diagnostic findings, treatment, management, and outcome of the first reported case of naturally occurring neurogenic stunned myocardium in a dog. Electrocardiogram monitoring, cardiac troponin I, and echocardiography should be considered in patients presenting with seizure activity, especially when exhibiting cluster seizures or in status epilepticus.

Background: Ventricular tachycardia storm is a syndrome defined by the presence of at least three episodes of ventricular tachycardia over a 24-h period, requiring termination by intervention. Standard therapy consists initially of using intravenous betablockers (if left ventricular ejection fraction is preserved) and Amiodarone, in addition to intravenous Lidocaine (in case of ischemic etiology) and light sedation. In the present case, a ventricular tachycardia storm episode is terminated by Esmolol, a particular intravenous betablocker, despite acute decompensated heart failure. Case presentation: We report the case of an 89-year-old patient presenting for a ventricular tachycardia storm and acute heart failure with reduced left ventricle ejection fraction of coronary ischemic origin that persisted despite coronary revascularization, oral betablocker, intravenous Amiodarone and Lidocaine, light sedation, and multiple electrical cardioversion. Emergency catheter ablation was not feasible due to meteorological conditions. We decided to use an intravenous betablocker despite the presence of acute heart failure. We favored use of intravenous Esmolol over other intravenous betablockers due to its short half-life and thus his rapid elimination, a unique characteristic for Esmolol. Intravenous Esmolol has successfully terminated the ventricular tachycardia without causing cardiogenic shock. Conclusions: Intravenous Esmolol can be used safely in patients with acute decompensated heart failure to terminate an electrical storm after failure of other measures. Close monitoring of the patient remains essential. [ABSTRACT FROM AUTHOR]

Younger women rely on altering cardiac output (Q̇$\dot{Q}$) to regulate blood pressure (BP). In contrast, older women rely more on altering vascular tone. However, evidence suggests that the ability to alter systemic vascular conductance (SVC) is diminished in older women. In the present study, cardioselective β‐blockade was utilized to diminish the relative contribution of Q̇$\dot{Q}$ to BP regulation and thereby evaluate age‐related vascular limitations in women at rest and during large muscle dynamic exercise. Younger (n = 13, mean age 26.0 years) and older (n = 14, mean age 61.8 years) healthy women performed submaximal bouts of semi‐recumbent cycling exercise at varying intensities while receiving an intravenous infusion of esmolol, a β1‐antagonist, or saline control in a repeated‐measures crossover design. Q̇$\dot{Q}$ was attenuated during esmolol infusion, with greater reductions during exercise (moderate, –1.0 (95% CI, –1.6 to –0.5) L/min, P < 0.001; heavy, –2.0 (95% CI, –2.6 to –1.5) L/min, P < 0.001) than seated rest (–0.5 (95% CI, –1.1 to 0.0) L/min, P = 0.048), and this reduction was not significantly different between age groups (P = 0.122). Older women exhibited a greater attenuation in mean arterial pressure (MAP) during esmolol (–7 (95% CI, –9 to –4) mmHg, P < 0.001) relative to younger women (–2 (95% CI, –5 to 0) mmHg, P = 0.071). These changes coincided with a greater reduction of SVC in the younger women during esmolol (–15 (95% CI, –20 to –10) mL/min/mmHg, P < 0.001) compared to older women (–3 (95% CI, –9 to 2) mL/min/mmHg, P = 0.242). Together, these findings provide evidence that older, postmenopausal women have a diminished ability to adjust SVC in order to regulate MAP. [ABSTRACT FROM AUTHOR]

Various anaesthetic agents and agents acting on the sympathetic system have been used to attenuate this sympathetic response to direct laryngoscopy and tracheal intubation, such as opioids, calcium channel blockers, local anaesthetics, beta-blockers, magnesium sulphate, dexmedetomidine, esmolol etc. The study involves the patients undergoing laparoscopic surgeries of the age group between 15 to 50 years. Informed written consent was taken from the patients of age 18 to 50 years and for those between 15 to 18 years, assent from the patient and informed written consent from the parents/guardian was obtained. All the patients were assessed preoperatively with history, clinical examination and required investigations. There was significant decrease in MAP observed upto 5 minutes after laryngoscopy and intubation in group E and MAP reached to baseline by 10th minute in group E. When compared to group D, MAP was maintained below the baseline which was seen statistically significant with the P value (<0.001) throughout the study period. [ABSTRACT FROM AUTHOR]

Dexmedetomidine could result in cardiovascular depression i.e. bradycardia and hypotension. The incidence of postoperative bradycardia has been reported as high as 40% in healthy surgical patients who received Dexmedetomidine, especially high doses. After obtaining approval and clearance from institutional ethical committee, 132 patients fulfilling the inclusion criteria will be enrolled for the study after obtaining informed consent. The study involves the patients undergoing laparoscopic surgeries of the age group between 15 to 50 years. Informed written consent was taken from the patients of age 18 to 50 years and for those between 15 to 18 years, assent from the patient and informed written consent from the parents/guardian was obtained. There was no significant side effects were noted in our study between group D and group E. [ABSTRACT FROM AUTHOR]

The article focuses on an 8-year-old girl diagnosed with atypical hemolytic uremic syndrome (aHUS) after presenting with non-bloody diarrhea, hemolytic anemia, and thrombocytopenia. Topics include her clinical presentation with elevated blood pressure and kidney involvement, the negative tests for shiga toxin and the normal ADAMTS-13 activity, and her subsequent treatment with plasma exchange and eculizumab, leading to improved kidney function and the cessation of dialysis.

Abstract Background Ventricular tachycardia storm is a syndrome defined by the presence of at least three episodes of ventricular tachycardia over a 24-h period, requiring termination by intervention. Standard therapy consists initially of using intravenous betablockers (if left ventricular ejection fraction is preserved) and Amiodarone, in addition to intravenous Lidocaine (in case of ischemic etiology) and light sedation. In the present case, a ventricular tachycardia storm episode is terminated by Esmolol, a particular intravenous betablocker, despite acute decompensated heart failure. Case presentation We report the case of an 89-year-old patient presenting for a ventricular tachycardia storm and acute heart failure with reduced left ventricle ejection fraction of coronary ischemic origin that persisted despite coronary revascularization, oral betablocker, intravenous Amiodarone and Lidocaine, light sedation, and multiple electrical cardioversion. Emergency catheter ablation was not feasible due to meteorological conditions. We decided to use an intravenous betablocker despite the presence of acute heart failure. We favored use of intravenous Esmolol over other intravenous betablockers due to its short half-life and thus his rapid elimination, a unique characteristic for Esmolol. Intravenous Esmolol has successfully terminated the ventricular tachycardia without causing cardiogenic shock. Conclusions Intravenous Esmolol can be used safely in patients with acute decompensated heart failure to terminate an electrical storm after failure of other measures. Close monitoring of the patient remains essential.

Mengjiao Song,1 Qiang Su,1 Lei Zhang2 1Department of The Second District of Intensive Care Medicine, Dongying People’s Hospital, Dongying, Shandong, People’s Republic of China; 2Department of Emergency Critical Care Medicine, Dongying People’s Hospital, Dongying, Shandong, People’s Republic of ChinaCorrespondence: Lei Zhang, Department of Emergency Critical Care Medicine, Dongying People’s Hospital, Nanyi Road NO. 317, Dongying, Shandong, 257091, People’s Republic of China, Tel +86-18554611031, Email Zhanglei8554zl@163.comObjective: To unveil the influence of norepinephrine (NE) combined with esmolol treatment on cardiac function, hemodynamics, inflammatory factor levels, and prognosis in patients with septic shock.Methods: Ninety-six patients with septic shock admitted to our hospital from January 2021 to June 2023 were retrospectively analyzed and divided into the control and observation groups according to the different treatment methods. The control group was treated with standard anti-infection and fluid resuscitation, followed by NE administration [with an infusion rate of 0.1– 0.5 μg/(kg-min)]. The observation group was treated with esmolol [starting pumping rate of 50 μg/(kg-min) and adjusting the pumping rate according to the target heart rate] in combination with the control group. Changes in hemodynamic parameters, including heart rate, mean arterial pressure, central venous pressure, cardiac index, stroke volume index, and systemic vascular resistance index, were monitored by pulse-indicating continuous cardiac output monitors before treatment (T0), 24h after treatment (T1), and 72h after treatment (T2); changes in cardiac function before and after 72h of treatment, indicators of inflammatory factors before and after treatment, and indicators of oxygenation metabolism were assessed; and adverse drug reactions during treatment were recorded in both groups.Results: NE combined with esmolol treatment improved the efficacy of patients with septic shock; was beneficial for the enhancement of blood perfusion in patients; improved the patient’s cardiac function, reduced myocardial injury, and suppressed the inflammatory response in patients; improved the oxygenation metabolism and the prognosis of patients; did not significantly increase the adverse drug reactions of patients and had a better safety profile.Conclusion: NE combined with esmolol treatment can improve the efficacy of patients with septic shock, improve their cardiac function and hemodynamic indices, reduce myocardial injury and inflammatory response, and have a better safety profile, which is conducive to improving patient prognosis and reducing mortality.Keywords: norepinephrine, esmolol, septic shock, cardiac function, hemodynamics, myocardial injury, inflammatory factor levels, prognosis

Abstract Background Sepsis is associated with a high incidence and mortality and poses a significant challenge to the treatment. Although esmolol has shown promise in sepsis treatment, its efficacy and safety remain contentious. This meta-analysis aims to clarify the role of esmolol in sepsis management. Methods PubMed, Embase, Web of Science, Cochrane library, clinicaltrials.gov and the Chinese Clinical Trial Registry were searched and references of relevant reviews and meta-analysis were also screened for appropriate studies. Keywords and free words of ‘sepsis’, ‘esmolol’ and ‘randomized controlled trials’ were used for search. Meta-analysis was performed using RevMan 5.3 software. Results Fifteen studies involving 1100 patients were included. Compared with the control group, patients receiving esmolol exhibited significantly decreased 28-day mortality (RR, 0.69; 95% CI, 0.60 to 0.81; P

Objective: Esmolol is an exceptionally effective cardio-selective β (1)-receptor blocking agent that demonstrates a swift onset and a brief duration of action. Our goal in this research was to delve into the utilization of esmolol, a potent intravenous beta blocker agent, among pediatric patients in the intensive care unit who possess various medical conditions. Method: Our research conducted over a span of two years between December 2020 and 2022, took place at the pediatric intensive care unit (PICU). The demographics, primary diagnoses, intensive care admission diagnoses, blood pressure levels, indications for starting esmolol, echocardiographic imaging findings of patients using esmolol infusion, esmolol doses, duration of use, reason for discontinuation, need for mechanical ventilation, use of inotropes, and pediatric risk of mortality score IV scores of patients using esmolol infusion were recorded in the data set. Results: The lowest starting dose of esmolol infusion (n=37) was determined as 25 mcg/kg/min and the highest dose as 250 mcg/kg/min. The median age of the deceased patients was significantly high. Additionally, the esmolol infusion doses of the surviving patients were higher. In the surviving patients, the median esmolol dose was found to be significantly higher, while the median age was significantly lower. Conclusion: The use of esmolol through intravenous infusion in PICUs requires careful consideration and monitoring of the patient’s hemodynamic and clinical parameters. Our experience has shown that esmolol can effectively regulate heart rate at low dosages.

Lei Liu,1,&ast; Shanshan Liu,2,&ast; Fuyan Bai,1 Yangxin Deng,1 Xinhuan Zhang,1 Li Wang3 1Department of Endocrinology, the Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, People’s Republic of China; 2General Gynecology, the Tai ‘an Central Hospital, Taian, Shandong, People’s Republic of China; 3Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinhuan Zhang; Li Wang, Email zhangxh22009@126.com; suxinlan1027@126.comBackground: An important factor in the pathogenesis of polycystic ovary syndrome (PCOS) is chronic low-grade inflammation. However, the exact pathophysiology of PCOS is currently unknown, which makes clinical diagnosis and the development of effective treatments more difficult. We aimed to investigate the role of the inflammatory response in initiating and progressing PCOS.Methods: 13 control granulosa cell samples and 15 granulosa cell samples from patients with PCOS were obtained from the GSE102293, GSE34526, and GSE5850 datasets. The gene set variation analysis (GSVA) method was used to calculate the inflammatory response score. Subsequently, the genes associated with inflammation in the hub were identified using differential expression analysis and weighted gene co-expression network analysis (WGCNA). The findings were confirmed by analysis of independent datasets and examination of clinical samples by qRT-PCR analysis. A consensus cluster analysis was conducted to categorize the PCOS samples into subtypes related to inflammation. Functional enrichment and analysis of immune cell infiltration were conducted to explore the potential mechanisms involved. Additionally, the CMap database was utilized to predict potential drugs, and the results were confirmed through molecular docking.Results: During the training cohort analysis, we identified five distinct genes (TGFBR2, ICAM3, WIPF1, SLC11A1, and NCF2) that could serve as potential diagnostic markers for PCOS. The expression levels of these genes were confirmed through validation in both the test set and clinical samples. In training cohort, two distinct inflammatory patterns (C1 and C2) were identified, and the C2 subtype exhibited activated immune- and inflammation-related pathways. Esmolol was shown to have potential as a drug to treat PCOS and it showed good results for molecular binding at TGFBR2, ICAM3, WIPF1, SLC11A1, and NCF2 proteins.Conclusion: Five diagnostic biomarkers and two inflammation-related molecular types associated with PCOS were identified, and esmolol was a potential drug for PCOS treatment. Our findings provided new diagnostic markers and potential small-molecule drugs for PCOS diagnosis and prevention.Keywords: polycystic ovary syndrome, inflammatory response, diagnostic biomarkers, molecular subtypes, esmolol

Background: Sepsis is associated with a high incidence and mortality and poses a significant challenge to the treatment. Although esmolol has shown promise in sepsis treatment, its efficacy and safety remain contentious. This meta-analysis aims to clarify the role of esmolol in sepsis management. Methods: PubMed, Embase, Web of Science, Cochrane library, clinicaltrials.gov and the Chinese Clinical Trial Registry were searched and references of relevant reviews and meta-analysis were also screened for appropriate studies. Keywords and free words of 'sepsis', 'esmolol' and 'randomized controlled trials' were used for search. Meta-analysis was performed using RevMan 5.3 software. Results: Fifteen studies involving 1100 patients were included. Compared with the control group, patients receiving esmolol exhibited significantly decreased 28-day mortality (RR, 0.69; 95% CI, 0.60 to 0.81; P < 0.0001), heart rate (HR) (SMD, -1.15; 95% CI, -1.34 to -0.96; P < 0.0001), cardiac troponin I levels (cTnI) (SMD, -0.88; 95% CI, -1.13 to -0.64; P < 0.0001), length of intensive care unit (ICU) stay (SMD, -0.46; 95% CI, -0.62 to -0.3; P < 0.0001) and duration of mechanical ventilation (SMD, -0.28; 95% CI, -0.48 to -0.09; P = 0.004) and significantly increased central venous oxygen saturation (ScvO2) (SMD, 0.66; 95% CI, 0.44 to 0.88; P < 0.0001).While, esmolol had no significant influence on norepinephrine dosage (SMD, 0.08; 95% CI, -0.13 to 0.29; P = 0.46), mean arterial pressure (MAP) (SMD, 0.17; 95% CI, -0.07 to 0.4; P = 0.16), central venous pressure (CVP) (SMD, 0.16; 95% CI, -0.04 to 0.35; P = 0.11) and left ventricular ejection fraction (LVEF) (SMD, 0.21; 95% CI, -2.9 to 0.7; P = 0.41). Conclusion: Esmolol reduces 28-day mortality, length of ICU stay and duration of mechanical ventilation in sepsis patients. Furthermore, esmolol improves oxygen metabolism, mitigates myocardial injury and decreases heart rate without significantly affecting hemodynamic parameters. Trial registration: This study was registered on the PROSPERO website (registration number: CRD42023484884). [ABSTRACT FROM AUTHOR]

Objective: Esmolol is an exceptionally effective cardio-selective β (1)-receptor blocking agent that demonstrates a swift onset and a brief duration of action. Our goal in this research was to delve into the utilization of esmolol, a potent intravenous beta blocker agent, among pediatric patients in the intensive care unit who possess various medical conditions. Method: Our research conducted over a span of two years between December 2020 and 2022, took place at the pediatric intensive care unit (PICU). The demographics, primary diagnoses, intensive care admission diagnoses, blood pressure levels, indications for starting esmolol, echocardiographic imaging findings of patients using esmolol infusion, esmolol doses, duration of use, reason for discontinuation, need for mechanical ventilation, use of inotropes, and pediatric risk of mortality score IV scores of patients using esmolol infusion were recorded in the data set. Results: The lowest starting dose of esmolol infusion (n=37) was determined as 25 mcg/kg/min and the highest dose as 250 mcg/kg/min. The median age of the deceased patients was significantly high. Additionally, the esmolol infusion doses of the surviving patients were higher. In the surviving patients, the median esmolol dose was found to be significantly higher, while the median age was significantly lower. Conclusion: The use of esmolol through intravenous infusion in PICUs requires careful consideration and monitoring of the patient’s hemodynamic and clinical parameters. Our experience has shown that esmolol can effectively regulate heart rate at low dosages. [ABSTRACT FROM AUTHOR]

Laryngoscopy and endotracheal intubation is commonly associated with hemodynamic changes due to reflex sympathetic stimulation. The hemodynamic changes are usually transitory, variable and unpredictable and are probably of no consequence in healthy individuals, but may be hazardous to those with history of pre-eclampsia, hypertension, cardiovascular or cerebrovascular diseases. A prospective randomized clinical study was undertaken in patients belonging to ASA-I physical status scheduled for elective surgeries under general anaesthesia with endotracheal intubation. Patients in Group D (n=36) received 0.5mcg/kg dexmedetomidine in 50mL NS over 10minutes before induction. Patients in Group E (n=36) received 0.5mg/kg esmolol diluted to 10mL over 60seconds after induction. The mean HR in dexmedetomidine group (maximum increase of 88.09±10.31 at intubation) was significantly lower than esmolol group (maximum increase of 93.72±8.27 at intubation), which was statistically significant but not clinically. SBP, DBP and MAP changes between the two groups were statistically insignificant at all points. We concluded that dexmedetomidine 0.5mcg/kg and esmolol 0.5mg/kg are comparable in attenuating the hemodynamic stress response to laryngoscopy and tracheal intubation without any adverse effects. [ABSTRACT FROM AUTHOR]

Background and aims: Extubation after an elective intubation for GA depends on patients preoperative status, the intraoperative course and expected post operative recovery. Increased cardiovascular instability during anaesthesia and abnormal cardiovascular responses to intubation and extubation have been described in patients with diabetic autonomic neuropathy. Aim: To assess the effectiveness of esmolol on blocking the hemodynamic response to extubation in diabetic and non-diabetic patients. Methodology: It is a comparative, randomized, prospective, observational study. A total of 42 patients of ASA grade 1 and 2 of either sex, aged 30 to 80 years, scheduled for elective surgeries under General Anaesthesia (GA) were randomly allocated into two groups of 21 each – Group A- Non-Diabetic, Esmolol received 1.5mg/kg IV 2 minutes before extubation Group B- Diabetic, Esmolol received 1.5mg/kg IV 2 minutes before extubation. Heart rate (HR), Systolic arterial pressure (SAP), Diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were recorded 1 minute before IV administration, during extubation at 1, 3, 5, and 10 minutes after extubation. Data analysis done using standard statistical tests and SPSS for windows software. Results: HR and BP values of the diabetic esmolol group were significantly lower as compared to the nondiabetic esmolol group. In group 1, HR at administration of drug, at extubation after 1,5 and 10 minutes was higher. In group 1, SAP at administration of drug, extubation after 1,3, 5 minutes was higher. DAP was higher in group 1. MAP was not statistically significant between two groups. Conclusion: Use of esmolol 1.5mg/kg dose 2 minutes before extubation is effective in diabetic and non-diabetic patients in preventing tachycardia and hypertension without any serious side effects. [ABSTRACT FROM AUTHOR]

Background: Functional Endoscopic Sinus Surgery, one of the less invasive procedures requires bloodless surgical field for proper visualisation. Intense bleeding is a major limitation of this procedure. Aim of this study was to compare induced controlled hypotension by Dexmedetomidine and Esmolol to provide better surgical field visibility. Methods: 40 consenting individuals scheduled for elective FESS fulfilling the inclusion criteria participated in this randomised, double-blinded, prospective, comparative study. They were sorted into 2 groups of 20 each randomly. Group D was administered Dexmedetomidine 0.5mcg/kg diluted to 60ml and Group E received Esmolol 0.75mg/kg diluted to 60ml as an infusion started at induction at the rate of 1ml/min over 1 hour. Haemodynamic variables like mean arterial pressure, systolic and diastolic blood pressure, heart rate and average category score were recorded at every 10 minutes for 1 hour. Any adverse effects during the study were noted. Results: In Group D, Mean arterial pressure(MAP), Systolic blood pressure(SBP) and Diastolic blood pressure(DBP) were all significantly lower than those of Group E, particularly at 30mins, 40mins, 50mins and 60mins after study drugs were started. No patients exhibited severe bradycardia, resistive hypotension or hypertension. No serious side effects were noted. In Average category score for quality of surgical field, group D showed grade 1 in majority patients even at 30 mins, 40 mins, 50 mins after start of infusion. Conclusion: Dexmedetomidine & Esmolol both are safe to produce controlled hypotension & good surgical field during FESS, but Dexmedetomidine has superior haemodynamic profile and added effects of analgesia & sedation. [ABSTRACT FROM AUTHOR]

Background & Aims: Endotracheal intubation is essential for safe general anesthesia practice but it is associated with stress response due to sympathetic stimulation resulting in hypertension and tachycardia. So, to attenuate this stress response during laryngoscopy and endotracheal intubation, the efficacy of intravenous dexmedetomidine and esmolol were compared in this study. Materials And Methods: The study was carried on total 210 ASA grade I or II patients of aged 18-60 years who were scheduled for elective laparoscopy surgery under general anesthesia. All the patients were randomly divided into the three groups of 70 each. In control group (group C)-intravenous (IV) 0.9% saline plain, dexmedetomidine group (group D)- 1 μg/kg dexmedetomidine and esmolol group (group E)- 1.5 mg/kg esmolol diluted with 0.9% saline in volume of 20 ml IV were infused over 10 minutes and after that induction of anaesthesia was done. Hemodynamic parameters were recorded atbaseline, before intubation, during intubation, and then every 1 minute upto 10 minutes. Results: In group D, increase in heart rate and blood pressure after intubation at any time intervals was not statistically significant, whereas in group E, there was a statistically significant increase in blood pressure after intubation at 1, 2, and 3 minutes only and in heart rate up to 5 minutes. Conclusion- Dexmedetomidine is better alternative to esmolol for attenuating the stress response to laryngoscopy and intubation during general anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30–45 years, either sex, Mallampati grade 1–2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation.

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30-45 years, either sex, Mallampati grade 1-2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation. [ABSTRACT FROM AUTHOR]

Abstract Background Disorders of the gut microbiome could be responsible for the progression of multiple organ dysfunction syndrome. In this study, we examined the effect of esmolol on the gut microbiome in a rat model of sepsis induced by cecal ligation and puncture (CLP). Methods The animals (n = 32) were randomly divided into 3 groups: Sham group (sham operation + normal saline treatment, n = 8), CLP group (cecal ligation and puncture + normal saline treatment, n = 12), and CLP + ESM group (cecal ligation and puncture + esmolol treatment, n = 12). After 24 h, feces in the colon were collected for 16S rRNA gene sequencing and nitric oxide analysis. In addition, colon was removed for immunohistochemical staining of inducible nitric oxide synthase (iNOS). Results Four rats in the CLP group and two rats in the CLP + ESM group died. The abundance of Lactobacillus in the CLP + ESM group was higher than CLP group (P = 0.048). In the linear discriminant analysis effect size analysis, Norank f Muribaculaceae, Escherichia–Shigella and Lactobacillus were the predominant bacteria in the Sham group, CLP group and CLP + ESM group, respectively. The iNOS expression in colonocytes stained by brown in the CLP group were much more than Sham group (P = 0.001). Compared to CLP group, the iNOS expression in colonocytes reduced after esmolol treatment (P = 0.013). The concentration of nitric oxide in colon feces was different in Sham group, CLP group and CLP + ESM group (1.31 ± 0.15μmmol/l vs. 1.98 ± 0.27μmmol/l vs. 1.51 ± 0.14μmmol/l, P = 0.001). In addition, the concentration of nitric oxide in CLP group was higher than Sham group (P = 0.001) or CLP + ESM group (P = 0.001). Conclusions Esmolol increased the fecal abundance of Lactobacillus in a rat model of sepsis. Moreover, esmolol reduced the iNOS expression of colonocytes and the nitric oxide concentration of colon feces.

Background: Rocuronium injection pain is a common side effect during anesthesia induction, causing patient dissatisfaction and rocuronium injection withdrawal movement, putting the patient at risk for serious complications. Objective: This study aims to compare the effectiveness and safety profile of esmolol, ketorolac, lidocaine, and placebo in a controlled randomized trial to establish the drug of choice, elevate patient satisfaction, and reduce perioperative adverse effects. Materials and Methods: About 176 patients were enrolled in the study and were randomly assigned to four groups; receiving pretreatment with 2 mL of 0.9% sodium chloride (group P), 1 mg/kg of lidocaine (group L), 10 mg of ketorolac (group K), and 0.5 mg/kg of esmolol (group S). Two minutes after the study drug infusion, 0.3 mg/kg of 1% rocuronium was injected. Pain was documented with the visual analog scale during and 1 min after rocuronium injection. Heart rate, blood pressure, and oxygen saturation were recorded multiple times during and after the operation. Results: The four groups showed significant differences in pain score (P < 0.001) with the least severe pain experienced in the esmolol group both during and 1 min after rocuronium injection. The mean heart rate was significantly lower in the esmolol group 20 (P = 0.03) and 30 (P = 0.03) min after surgery. Conclusion: Pretreatment with esmolol is effective in reducing pain on rocuronium injection and its subsequent effects, and despite causing bradycardia, a manageable side effect, esmolol has an otherwise acceptable safety profile. Hence, esmolol can be a favorable choice in reducing pain caused by rocuronium injection.

Background: To reduce airway and circulatory responses during extubation, various pharmacological and non-pharmacological methods have been used such as opioids, inhalational agents, local anaesthetics, vasodilators, alpha blockers, beta blockers, and calcium channel blockers. Present study was aimed to compare the hemodynamic effects of esmolol and lidocaine in attenuation of haemodynamic responses to tracheal extubation in neurosurgical patients. Material and Methods: Present study was single centric, observational, prospective, comparative study, conducted in patients with ASA 1 & 2, undergoing neurosurgical procedure (elective and emergency) with invasive blood pressure monitoring. Patients were divided in two group as Group 1 (Esmolol, n=30) & Group 2 (Lignocaine, n=30). Results: No significant difference was seen in the age wise distribution, gender wise distribution, mean weight & ASA grade distribution of patients enrolled in both groups. No significant difference in heart rate was seen among patients in both the group at baseline and at pre reversal stage. Average heart rate was significantly higher among patients in lignocaine after pre reversal stage from min 1 to 15 min. No significant difference in SBP was seen among patients in both the group at baseline and at pre reversal stage. Average SBP was significantly higher among patients in lignocaine after pre reversal stage from min 1 to 15 min. Nausea - vomiting were the two most common side effect seen among patients in both the group. No significant difference was seen among the reported side effect. Majority of patients in both the group has no coughing at extubation. No significant difference in the quality of extubation was seen among patients in both group Conclusion: No difference in the side effect was seen among patients in both group & majority of patients has smooth extubation with no coughing episode. [ABSTRACT FROM AUTHOR]

This article discusses a study that evaluated the efficacy and safety of the ß-blocker esmolol in controlling heart rate in neonatal cardiac surgery with cardiopulmonary bypass (CPB) for transposition of the great arteries (TGA). The study included 112 neonates who underwent arterial switch operation for d-TGA between 2012-2021. Of these, 52% received esmolol within the first 12 hours following CPB. The results showed that esmolol was effective in reducing heart rate in these patients without any significant side effects. The study suggests that esmolol can be safely used to treat sinus tachycardia following CPB in neonates undergoing arterial switch operation. [Extracted from the article]

A 4-year-old male neutered Boston Terrier was presented with status epilepticus. He was diagnosed with idiopathic epilepsy and hospitalized with supportive care. During hospitalization, the patient developed both supraventricular and ventricular arrhythmias as well as focal left ventricular dyskinesis. Cardiac troponin I was significantly increased, which was supportive of myocardial damage. Neurogenic stunned myocardium was suspected, and the patient was treated and responded to esmolol. Follow-up echocardiography demonstrated the resolution of the ventricular dyskinesia. This report describes the clinical presentation, diagnostic findings, treatment, management, and outcome of the first reported case of naturally occurring neurogenic stunned myocardium in a dog. Electrocardiogram monitoring, cardiac troponin I, and echocardiography should be considered in patients presenting with seizure activity, especially when exhibiting cluster seizures or in status epilepticus.

ABSTRACTBackground 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 Background Amiodarone and esmolol can help to prevent and treat post-cardiac surgery reperfusion ventricular fibrillation. However, the relative efficacies of these two drugs remain unknown. The aim of the current trial is to compare the performances of amiodarone and esmolol for preventing reperfusion ventricular fibrillation following open heart surgery. Methods/design This is a single-center, prospective, double-blind, controlled clinical trial. A total of 260 patients undergoing heart valve or aortic surgery will be assigned randomly to treatment with prophylactic esmolol (intervention group) or amiodarone (control group). The main outcome is the incidence of reperfusion ventricular fibrillation following aortic opening during extracorporeal circulation. The secondary outcomes are the rate of automatic cardiac resuscitation, energy and frequency of electrical defibrillation, number of electrical defibrillations, and pacemaker use in the two groups of patients. Information on the patients’ general condition and the durations of anesthesia, extracorporeal circulation, aortic occlusion, and operation time will be recorded. We will also compare the heart rate, mean arterial pressure, and central venous pressure between the two groups of patients at induction of anesthesia (T1), start of surgery (T2), start of extracorporeal circulation (T3), aortic block (T4), aortic opening (T5), after opening for 10 (T6), 20 (T7), and 30 min (T8), at cessation of extracorporeal circulation (T9), and at the end of surgery (T10) and compare blood gas analysis results at T1, T5, T9, and T10. Discussion This study will determine if prophylactic esmolol is more effective than amiodarone for reducing the incidence of reperfusion ventricular fibrillation in patients undergoing heart valve or aortic surgery. Trial registration China Clinical Trials Registry ChiCTR1900026429. Registered on 2019.10.9.

Sepsis is a potentially fatal organ failure resulting from a dysregulated host response to infection. It can be a substantial financial burden on families and society due to the high cost of medical care. The study aims to investigate the protective roles of Esmolol in mice with sepsis-induced brain injuries against cognitive dysfunction and neuronal inflammation. Male C57BL/6J mice were intraperitoneally injected with LPS (10 mg/kg, L2630, Sigma) to establish a septic encephalopathy model. Esmolol (15 mg/kg/h, HY-B1392, MedChemExpress) was subcutaneously infused using osmotic mini-pumps for 6 h before LPS injection. Morris water maze and novel object recognition tests evaluated LPS-induced cognitive impairment and behavioral phenotypes. Cytokines and protein expression were assessed using ELISA assay and RT-qPCR. Esmolol treatment potentially improved cognitive impairment in septic mice. Esmolol administration markedly diminished the abnormal hippocampal neuronal structure, and the expression of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α was significantly downregulated in the hippocampal tissue. Esmolol treatment significantly reduced apoptotic TUNEL-positive cells and reversed the related gene expression (BAX and BCL-2). The effects of esmolol on the reactive oxidative species and oxidative stress markedly reduce malondialdehyde MDA content and increase superoxide dismutase and catalase in hippocampal tissues. In addition, esmolol significantly reduced the percentage and density of Iba-1 + microglia in septic mice. Our results demonstrated that esmolol potentially improved cognitive impairment and neuronal inflammation in mice with sepsis-induced brain injury.

Background: Few trials have examined the efficacy of esmolol to attenuate hemodynamic and respiratory responses during extubation. However, the most appropriate dose of esmolol and an optimal protocol for administering this beta-blocker are uncertain. Methods: Ninety patients ASA physical status I, II, and III (aged 18...60 years) scheduled to procedures with general anesthesia and tracheal extubation were selected. Patients were randomized into esmolol and placebo group to evaluate the efficacy and safety of a single bolus dose of esmolol (2...mg.kg-1) on cardiorespiratory responses during the peri-extubation period. The primary outcome was the rate of tachycardia during extubation. Results: The rate of tachycardia was significantly lower in esmolol-treated patients compared to placebo-treated patients (2.2% vs. 48.9%, relative risk (RR): 0.04, 95% confidence interval (95% CI)...=...0.01 to 0.32, p...=...0.002). The rate of hypertension was also significantly lower in the esmolol group (4.4% vs. 31.1%, RR: 0.14, 95% CI 0.03 to 0.6, p...=...0.004). Esmolol-treated patients were associated with higher extubation quality compared to patients who received placebo (p...

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]

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 evaluate the haemodynamic stress response rin combination of lidocaine and esmolol versus lidocaine or esmolol alone during laryngoscopy and intubation. Methods: This research comprised 60 patients who provided written permission and met the inclusion and exclusion criteria. Selected patients were randomly assigned to one of three groups based on a computer-generated random number: lignocaine 1.5 mg/kg (n = 40), esmolol 2 mg/kg (n = 40), or lignocaine 1 mg/kg and esmolol 1 mg/kg (n = 40). This research comprised patients aged 20 to 42 who had elective procedures under general anaesthetic and had ASA I and II. Patients with contraindications to beta blockers, such as bronchial asthma, COPD, a basal heart rate of 60 beats per minute, respiratory impairment, and documented reactions to local anaesthetics. Results: There were no significant variations in age, preoperative heart rate, or blood pressure between the groups. Males and females were approximately equally dispersed throughout all groupings. Following the delivery of the test medicines, all three groups saw a substantial drop in heart rate (Group E 61.23 ± 3.64, Group L 73.25 ± 5.36, Group LE 72.23 ± 5.36) (P < 0.001). Four Group E patients developed bradycardia. (HR <60). Although both Group LE and Group L showed near baseline values, Group L showed near baseline values until the third minute, whereas Group LE showed a continuous reduction in heart rate rates. After 30 minutes, all three groups' heart rates were statistically insignificant. Following induction and administration of the test medicines, systolic, diastolic, and hence mean arterial blood pressure lowers gradually in all three groups (P < 0.001). (This is for systolic blood pressure.). Group E 97.36 ± 5.69, Group L 125.39 ± 6.36, Group LE 116.78 ± 4.78) Group E 60.034.69, Group L 82.935.36, Group LE 72.034.78) (Group E 72.10 ± 3.69, Group L 96.90 ± 3.85, Group LE 86.44 ± 2.87) Before intubation, patients in Group E experienced substantial decreases in systolic, diastolic, and mean arterial blood pressure (less than 20% of baseline). Following intubation, blood pressure levels in Group LE were near baseline until the 30th minute (P < 0.001). Group E had a consistent fall in all three blood pressure readings following intubation until the fifth minute. Group E's blood pressures were likewise around baseline at the 15th and 30th minutes. Until the 15th minute, Group L had a considerable rise in all three blood pressures. Conclusion: As a result, esmolol and lidocaine together are a safe and effective strategy to minimise laryngoscopy responses to intubation and extubation, lowering myocardial oxygen consumption and the risk of myocardial ischemia under general anaesthesia. [ABSTRACT FROM AUTHOR]

Purpose Acute hyponatremia can lead to severe neurological symptoms such as confusion, obtundation, seizures, coma, and respiratory depression, contributing to increased morbidity and mortality. Patients with acute hyponatremia should be evaluated based on volume status and serum osmolality to determine potential causes and appropriate treatment. The aim of this case report is to illustrate the importance of using a multidisciplinary approach to evaluate medication formulation and the potential impact on a patient's clinical course. Summary A 34-year-old male was admitted for type A aortic dissection and was treated with an esmolol infusion and underwent operative repair. Two days after initiation of esmolol, the patient developed seizures and antiepileptics were initiated. The patient's serum sodium concentration was found to have decreased by a total of 14 mEq/L since admission. The patient had received more than 6 L of esmolol formulated in sterile water over the course of 2 days. The esmolol infusion was converted to another antihypertensive agent, and 0.9% sodium chloride injection was initiated, after which the serum sodium concentration began to recover. No further seizures were observed on continuous electroencephalography, and all antiepileptic drugs were discontinued with no seizure activity. Conclusion The esmolol product utilized in this case was formulated in 250 mL of sterile water, which is suspected to have contributed to the patient's hyponatremia. It is important to be aware of the formulation and excipients of medications and their potential for adverse effects. [ABSTRACT FROM AUTHOR]

Background: FESS has its share of complications which can be a challenge for both the surgeon as well the anesthetist and achieving a bloodless surgical field is essential So the principle of controlled hypotension can be used to combat this issue. Methods: A hospital-based randomized comparative interventional study was conducted on 60 patients to compare Clonidine (2mcg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mcg/kg/hr during maintenance) and Esmolol (1mg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mg/kg/hr during maintenance) to assess and compare the hypotensive properties of both the drugs. Results: After the induction of anesthesia, there was a significant difference in the mean heart rate, and mean arterial pressure between the two groups throughout the intraoperative period (p-value < 0.05). Both groups achieved a target mean arterial pressure (MAP) of 65-70 mmHg and improved surgical field quality. Conclusion: This study concluded that clonidine and esmolol both provide hemodynamic stability and a better surgical field in functional endoscopic sinus surgery (FESS). Clonidine also helps in achieving postoperative sedation and analgesia.

OBJECTIVE To compare cardiac output (CO) measurements by transesophageal echocardiography (TEECO) and esophageal Doppler monitor (EDMCO) with pulmonary artery thermodilution (PATDCO) in anesthetized dogs subjected to pharmacological interventions. The effect of treatments on EDM-derived indexes was also investigated. ANIMALS 6 healthy male dogs (10.8 ± 0.7 kg). METHODS Dogs were anesthetized with propofol and isoflurane, mechanically ventilated, and monitored with invasive mean arterial pressure (MAP), end-tidal isoflurane concentration (ETISO), PATDCO, TEECO, EDMCO, and EDM-derived indexes. Four treatments were administered to all dogs by randomization. Baseline data were collected before each treatment: (1) dobutamine infusion; (2) esmolol infusion; (3) phenylephrine infusion; and (4) ETISO > 3%. Data were collected after 10-minute stabilization and after 30 minutes of washout between treatments. Statistical tests were pairwise t test, Bland-Altman analysis, Lin's concordance correlation (ρc), and polar plot analysis with P < .05 set as significance. RESULTS The mean ± SD relative bias (limits of agreement) for TEECO was 0.35 ± 25.2% (-49.1% to 49.8%) and for EDMCO was -27.2 ± 22.5% (-71.4% to 17%) versus PATDCO. The percent error for TEECO and EDMCO was 27.6% and 44.1%, respectively. The ρc value was 0.82 for TEECO and 0.66 for EDMCO. TEECO and EDMCO showed good trending ability. EDMderived indexes displayed significant changes specific to the drug administered (P < .001). CLINICAL RELEVANCE For minimally invasive CO monitoring, TEE may provide more favorable performance than EDM in clinical settings; however, EDM-derived indexes yield valuable hemodynamic information that reliably follows trends in CO, thus supporting critical decision-making in canine patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Cardiac output (CO) measurement devices are classified as invasive, minimally invasive, or noninvasive depending on their level of invasiveness for CO data acquisition. Pulmonary artery thermodilution is the 'gold standard' CO technique. This method is more accurate, but its invasiveness possesses risks. Minimally invasive lithium dilution (LiD) is slowly replacing thermodilution as a reference standard in animal research due to its excellent agreement and acceptable performance. Monitoring CO with standard cardiovascular parameters (i.e., blood pressure and heart rate) in anesthetized animals can potentially improve patient care and case outcomes. Hence, we evaluated noninvasive electrical cardiometry (EC)-measured CO and other EC-acquired hemodynamic variables, and analyzed them against CO measured using LiD in healthy, anesthetized dogs during different treatments (dobutamine, esmolol, phenylephrine, and high-dose isoflurane) impacting CO values. Overall, EC showed good agreement with LiD, but it exhibited consistent underestimation when the CO values were higher. The percentage error was low and within published standards, and a good trending pattern was exhibited by EC. The acquired EC variables followed the trends in CO obtained by LiD. EC may be a pivotal tool for monitoring trends in hemodynamics and guiding treatments for cardiovascular anesthetic complications in clinical settings. Numerous cardiac output (CO) technologies were developed to replace the 'gold standard' pulmonary artery thermodilution due to its invasiveness and the risks associated with it. Minimally invasive lithium dilution (LiD) shows excellent agreement with thermodilution and can be used as a reference standard in animals. This study evaluated CO via noninvasive electrical cardiometry (EC) and acquired hemodynamic variables against CO measured using LiD in six healthy, anesthetized dogs administered different treatments (dobutamine, esmolol, phenylephrine, and high-dose isoflurane) impacting CO values. These treatments were chosen to cause drastic variations in CO, so that fair comparisons between EC and LiD across a wide range of CO values (low, intermediate, and high) could be made. Statistical analysis included linear regression, Bland–Altman plots, Lin's concordance correlation coefficient (ρc), and polar plots. Values of p < 0.05 represented significance. Good agreement was observed between EC and LiD, but consistent underestimation was noted when the CO values were high. The good trending ability, ρc of 0.88, and low percentage error of ±31% signified EC's favorable performance. Other EC-acquired variables successfully tracked changes in CO measured using LiD. EC may be a pivotal hemodynamic tool for continuously monitoring circulatory changes, as well as guiding and treating cardiovascular anesthetic complications in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a Sodium channel blocker attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a Calcium channel blocker attenuates hemodynamic response by blocking voltage sensitive L type channels, and inhibiting calcium entry mediated action potential in smooth and cardiac muscle. It also has peripheral vasodilation property. Esmolol, a Beta blocker attenuates hemodynamic response by blocking sympathetic nervous system. Methodology-90 patients admitted for elective surgeries posted under general anaesthesia at Kidwai memorial institute of oncology, Bangalore during the duration of December 2018 to May 2019 were included in the study. Patients were randomly divided into 3 groups of 30 each. Randomization done by computer generated table. Group A: received Inj. Diltiazem 0.1mg/kg and preservative free lignocaine 1mg/kg. Group B: received Inj. Esmolol 0.5mg/kg and lignocaine 1mg/kg. Group C: received Inj. lignocaine 1mg/kg. Hemodynamic parameters HR, SBP, DBP, MAP were recorded before extubation (pre reversal) and 1min, 2mins, 3mins, 5mins and 10mins post extubation. In this study, the dosage was fixed based on previous studies. Results-Post extubation, the decrease in mean heart rate was statistically significant in Group B in comparison with Group C (control group) from 1 min post extubation till 10 min. There was increase in heart rate in Group A compared to Group C (control group) which is not statistically significant. Also there was slight decrease in heart rate in Group B compared to Group A (both study group) which is statistically significant at all the intervals. Conclusion-Smaller doses of esmolol when combined with lignocaine gives much better results when compared to Diltiazem + Lignocaine combination and lignocaine alone. [ABSTRACT FROM AUTHOR]

Hypotensive anesthesia in specific types of surgeries brings about certain advantages such as decreased blood loss as well as better surgeon satisfaction regarding the surgical field. Of the various modalities by which this can be achieved, one of the most popular is by introducing a hypotensive agent to bring about the desired hypotension. Here, we aim to review a few studies regarding the use of various hypotensive agents for hypotensive anesthesia and try to come to learn the various modes of action of these said drugs, their specific indications or situations where they may be preferred as well as the various advantages and disadvantages that accompany their use. [ABSTRACT FROM AUTHOR]

Background and Objectives: High blood pressure and heart rate are common side effects of laryngoscopy and tracheal intubation, triggered by the body's reactive sympathetic pressor response. In patients at high risk, this could have a negative impact. The purpose of this research is to examine how lignocaine and esmolol affect this reaction and to draw comparisons between the two. Methods: One hundred and fifty normotensive patients with ASA I or II status who were scheduled for elective surgery were selected at random and split into three groups of 50. All patients were premedicated with 0.2 milligrammes of pentazocine intravenously and 0.02 milligrammes of midazolam intravenously. All patients were given the same dose of intravenous thiopentone (5 mg/kg) for induction of anaesthesia. Succinylcholine 2 mg/kg i.v. with 0.01% glycopyrrolate mg/kg produced a calming effect. The initial batch did not get any dampening. Three minutes before laryngoscopy and intubation, the second group received an intravenous bolus of 1.5 mg/kg lignocaine, whereas the third group received an intravenous bolus of 2 mg/kg Esmolol. Noninvasive measurements of heart rate and systolic and diastolic blood pressure were taken at 0, 1, 3, 5, and 10 minutes after laryngoscopy had begun. Statistical significance was determined using the 'Z' test. Results: Following intubation, the incidence of tachycardia with a heart rate of more than 100 beats per minute was substantially higher in the control and lignocaine groups than in the esmolol group (z>1.96, p0.05-0.001) The control group and the lignocaine group both showed a statistically significant rise in their blood pressure compared to the esmolol group (z > 1.96, p 0.05). Conclusion: Both lignocaine and esmolol have been shown to have the effect of dampening the pressor response. When compared to lignocaine 1.5mg/kg i.v bolus, the attenuation provided by esmolol 2 mg/kg i.v bolus is more constant, dependable, and effective than that provided by lignocaine 1.5mg/kg i.v bolus. [ABSTRACT FROM AUTHOR]

Abstract Background Electrical storm (ES) is a heterogeneous clinical emergency that can present with malignant ventricular arrhythmias such as ventricular fibrillation (VF), ventricular tachycardia (VT), requiring the need for cardiac defibrillation. ES is a life-threatening condition with a high mortality rate. Successfully managing ES in the setting of acute myocardial infarction (MI) is expected to be known by physicians on call to reduce in-hospital mortality. Case presentation A 57-year-old man presenting with acute onset chest pain was found to have an infero-posterior ST-segment elevation myocardial infarction (STEMI) complicated by acute right ventricular MI secondary to total occlusion of the proximal right coronary artery (RCA). The patient developed ES in the form of recurrent VF that was managed successfully with electrical defibrillation, antiarrhythmic therapy with amiodarone and esmolol, endotracheal intubation, sedation, electrolyte replacement, volume resuscitation, comfort care, psychological intervention, and percutaneous coronary intervention (PCI) of the occluded epicardial artery. With these interventions used in quick succession and with the aspiration of a massive RCA thrombus, the patient was reversed to hemodynamic stability, did not have further episodes of VF, and survived the index hospitalization. Conclusion ES is a rare but fatal complication of acute MI. Residents on night shifts should be better prepared and equipped to deal with this rare condition. We hope our successful experience can benefit physicians on call who take care of acute MI patients that deteriorate with ES.

Objective: In this prospective, single blind-randomized study, we aimed to investigate the effect of controlled hypotension by esmolol vs. remifentanil on cerebral oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) in patients undergoing functional endoscopic sinus surgery (FESS). Material and Methods: One hundred fifty patients undergoing elective FESS under controlled hypotension were evaluated for study inclusion. Group allocation was performed in a randomized fashion. Controlled hypotension was provided using continuous remifentanil (Group R) or esmolol (Group E) infusion. rSO2 was assessed during controlled hypotension by NIRS monitoring. Demographic data, hemodynamic values, and rSO2 were recorded preoperatively, postinduction 5th min, intraoperatively (10,20,30,45,60,90 minutes), and 5 and 10 minutes after stopping hypotensive agents. The duration of surgery and anesthesia and surgeon satisfaction score were also recorded. Results: 126 patients were included in the study. Among the demographic data, only weight was found significantly different between the groups. The unfortunate fact is that there was no significant difference in the mean of minimum rSO2(p=0.186) and also in the median of the minimum mean arterial blood pressure (MAP) (p=0.312) between Group R and Group E. Surgeon satisfaction score was significantly higher in Group R (p<0.001). rSO2 (p<0.001, R2=0.67) was detected as the best predicting factor by the multiple regression model. While Heart rate (HR), MAP, and preinduction rSO2 added statistically significantly to the prediction(p<0.001), the type of hypotensive drug did not (p=0.979). Conclusion: Esmolol and remifentanil used for controlled hypotension did not cause significant rSO2 changes. Among the factors affecting rSO2 MAP, HR, and pre-induction rSO2 were detected, while the best predictor factor was pre-induction rSO2. Remifentanil provides a better surgical field than esmolol according to the VAS scale. [ABSTRACT FROM AUTHOR]

Rapid arrhythmia (RA) is a major complication of severe heart failure (SHF). Treatment with anti-arrhythmic drug amiodarone though improves the myocardial blood supply and suppress arrhthmia, its clinical application is not satisfactory. Amiodarone combined with another class II antiarrhythmic drug esmolol shows rapid onset and good efficacy. Here, we studied the effects of amiodarone and esmolol in severe heart failure (SHF) with rapid arrhythmia (RA) and its effect on TGF-ß1, APN and PIIINP. A total of 180 SHF patients with RA treated at Zhejiang Provincial Hospital of Traditional Chinese Medicine were selected and divided into experimental group (n = 90) and control group (n = 90) according to the random number table method. The control group was given routine therapy + amiodarone therapy, and the experimental group was given routine therapy + amiodarone + esmolol therapy. Cardiac function measures including cardiac index (CI), mean arterial pressure (MAP) and ejection fraction (LVEF), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR), serum TGF-ß1, APN and PIIINP levels were observed in both groups before and 48 h after treatment. After treatment, the CI, MAP and LVEF of the experimental group were greater than those of the control group (P <0.05); DBP, SBP and HR were greater (or higher) in the experimental group than in the control group (P <0.05); serum TGF-ß1 and PIIINP levels in experimental groups were all lower than in control group and serum APN levels were higher (P <0.05) than in control group. The total effective rate of the experimental group was less than that of the control group (P <0.05). There was no difference in the incidence of adverse effects between the two groups (P >0.05). The results indicate that treatment of severe heart failure (SHF) with rapid arrhythmia (RA) by amiodarone and esmolol may safely enhance cardiac function, blood pressure and heart rate, improve efficacy, inhibit the progression of myocardial fibrosis, and improve serum TGF-ß1, APN and PIIINP levels. [ABSTRACT FROM AUTHOR]

Introduction: Airway management in elective surgeries is best with endotracheal intubation. Both laryngoscopy and endotracheal intubation produce marked reflex sympathoadrenal stimulation which gives rise to hypertension and tachycardia. These reflex peaks within 1 min and ends in about 5-10 min after intubation which increases complications like myocardial ischemia left ventricular failure, and cerebral haemorrhage especially in patients with cardiovascular disease. Dexmedetomidine is a novel alpha-2 adrenergic agonist which decreases sympathoadrenal response and maintains haemodynamic stability during laryngoscopy and endotracheal intubation. Esmolol is a rapid onset, ultra-short acting, cardioselective beta-1 adrenergic receptor antagonist that possesses little sedative effect, but no analgesic activity and proved to be an effective agent to provide haemodynamic stability during laryngoscopy and endotracheal intubation. In the present study, we compared the effectiveness between Dexmedetomidine and Esmolol for attenuating haemodynamic response to laryngoscopy and endotracheal intubation during surgery under general anaesthesia. Methods: The present study was undertaken from November 2021 - June 2022, among 80 patients undergoing routine surgery under general anaesthesia randomly divided into 2 groups of 40 patients each by using a sealed envelope technique. Group D (Dexmedetomidine): consisting of 40 patients who received Dexmedetomidine 0.5µg/kg in 100ml normal saline, 3 minutes prior to intubation. Group E (Esmolol): consisting of 40 patients who received 1 mg/kg Esmolol, 3 minutes prior to intubation. Results: There was a statistically significant lower HR, SBP, DBP and MAP in group D compared to group E during laryngoscopy and 1, 3, 5 and 7 minutes after endotracheal intubation. Conclusion: We can conclude that administration of a single dose of dexmedetomidine 0.5 µg/kg i.v. before laryngoscopy was an effective method for attenuating the hemodynamic response to endotracheal intubation compared to a single dose of esmolol 1 mg/kg i.v. [ABSTRACT FROM AUTHOR]

Objective: Laryngoscopy and intubation cause hypertension, tachycardia and arrhythmia. Ischemia modified albumin (IMA) is formed secondary to endothelial or extracellular hypoxia, acidosis and free oxygen radicals and can be detected in the early stages of ischemia. In this study, we aimed to compare the effects of two agents on preventing hypertension and tachycardia by measuring IMA levels. Methods: Following ethics approval and randomization, dexmedetomidine 0.5 μg kg-1 in Group D (n=21) or esmolol 0.5 mg kg-1 in Group E (n=21) diluted in 20 mL saline was given as infusion for 5 minutes prior to induction. Patients in Group C (n=21) received only 20 mL saline infusion. An automated perfusor was set at 4 mL min-1 for the delivery of study solutions. Blood samples for IMA measurement were taken following monitorization and at 10th and 20th minutes after intubation. Results: There was no statistically significant difference concerning IMA levels at 10 minutes following intubation. However, IMA levels in Group C were significantly lower compared to Group E and Group D (p=0.025 and 0.015 respectively) at 20 minutes. There was no significant difference between Group E and Group D (p=0.980). In Group D and E, a significant drop in systolic, diastolic and mean arterial pressures compared to baseline was observed after the study drugs were given. Groups were similar in terms of heart rate in the first 5 minutes however Groups E and D had lower heart rates compared to Group C starting from the 6th minute until the end of study period. Conclusion: Inhibiton of hemodynamic response to intubation may have negative results, and pharmacological interventions for this should be carried out with caution in critical patients and close hemodynamic monitorization should be kept in mind. [ABSTRACT FROM AUTHOR]

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.

Background: Esmolol as one treatment of sepsis induced cardiomyopathy (SIC) is still controversial. The objective of this study is to evaluate cardiac function after reducing heart rate by Esmolol in patients with SIC using speck-tracking echocardiography. Methods: This study was a single-center, prospective, and randomized controlled study. A total of 100 SIC patients with a heart rate more than 100/min, admitted to the Intensive Care Department of Tianjin Third Central Hospital from March 1, 2020 to September 30, 2021, were selected as the research subjects. They were randomly divided into the Esmolol group (Group E) and the conventional treatment group (Group C), each with 50 cases. The target heart rate of patients in Group E was controlled between 80/min and 100/min. Speck-tracking echocardiography (STE) and pulse indicating continuous cardiac output monitoring (PICCO) were performed in both groups at 1 h, 24 h, 48 h, 72 h, 96 h and 7 d after admission, with data concerning left ventricular global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and global ejection fraction (GEF), left ventricular systolic force index (dP/dtmx) were obtained, respectively. Hemodynamics and other safety indicators were monitored throughout the whole process. These subjects were followed up to 90 d, with their mortality recorded at Day 28 and Day 90, respectively. Statistical analyses were performed using SPSS version 21. Results: With 24 h of Esmolol, all patients in Group E achieved the target heart rate, and there was no deterioration of GLS, or adverse events. However, compared with those in Group C, their GLS, GEF and dP/dtmx were increased, and the difference was statistically significant (P > 0.05). Compared with patients in Group C, those in Group E had lower short-term mortality, and logistic regression analysis also suggested that Esmolol improved patient outcomes. Conclusion: In SIC patients, the application of Esmolol to lower heart rate decreased their short-term mortality while not making any impairment on the myocardial contractility. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100047513. Registered June 20, 2021- Retrospectively registered, http://www.chictr.org.cn/index.aspx. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines. [ABSTRACT FROM AUTHOR]