Effect of esmolol on hemodynamics and intraocular pressure response to succinylcholine and intubation following low-dose alfentanil premedication.
OBJECTIVE
To determine the effectiveness of esmolol hydrochloride (Brevibloc) as an additional adjunct to low-dose alfentanil premedication in controlling the hemodynamic response [heart rate (HR), mean arterial pressure (MAP), and intraocular pressure (IOP)] to succinylcholine and endotracheal intubation.


METHODS
Randomized, double-blind, placebo-controlled, prospective study.


METHODS
Ambulatory gynecologic surgery at a university medical center.


METHODS
Twenty ASA physical status I and II female patients scheduled for outpatient laparoscopy under general anesthesia.


METHODS
All patients received alfentanil 10 micrograms/kg as a preoperative medication 4 minutes prior to induction of anesthesia. Study patients (n = 10 in each group) received either esmolol 1.5 mg/kg or a placebo (normal saline) 30 seconds prior to induction (210 seconds after alfentanil and 90 seconds prior to endotracheal intubation). Anesthesia was induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg. Postintubation, 70% nitrous oxide, 30% oxygen, and 1% isoflurane were administered.


RESULTS
Time of study drug administration was defined as time zero. Measurements of HR, MAP, and IOP were made at baseline (patient awake) and at each minute from minutes 1 through 6 after administration of the study drug (time zero). Analysis of variance was used to analyze the data, with a value of p less than 0.05 considered significant. Esmolol 1.5 mg/kg was found to blunt the maximum increase in HR but not MAP or IOP following low-dose alfentanil premedication.


CONCLUSIONS
In an eye patient with coronary artery disease, or in any patient in whom tachycardia may be detrimental, esmolol may be a useful adjunct in combination with low-dose alfentanil to attenuate the increase in HR due to laryngoscopy and endotracheal intubation.
Department of Anesthesiology, University of Kansas Medical Center, Kansas City 66160-7415.
A L
AL
Kovac
P S
PS
Bennets
S
S
Ohara
B A
BA
LaGreca
J A
JA
Khan
J W
JW
Calkins
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage / Q000494:pharmacology*; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D007442:Intubation, Intratracheal; D010919:Placebos; D011229:Preanesthetic Medication; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D013390:Succinylcholine / Q000008:administration & dosage / Q000494:pharmacology*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D010919:Placebos; D011412:Propanolamines; D015760:Alfentanil; D013390:Succinylcholine; C036604:esmolol