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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.

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]

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

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 & 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.

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: 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]

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. [ABSTRACT FROM AUTHOR]

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.

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.