title: Use of esmolol to prevent hemodynamic changes during intubation in general anesthesia.
abstract: To assess the minimal effective dosage of esmolol to prevent hypertension and tachycardia during laryngoscopy and endotracheal intubation in fentanyl-pretreated anesthesia, a double-blinded, randomized study was conducted. Two hundred patients undergoing elective, noncardiac surgeries were randomly allocated into four groups: group A received saline, group B esmolol 20 mg, group C esmolol 40 mg and group D esmolol 60 mg intravenously. General anesthesia was induced with 0.1 mg/kg vecuronium, 5 micrograms/kg fentanyl and 0.3 mg/kg etomidate. Heart rates (HR), systolic blood pressures (SBP), mean arterial pressures (MAP) and diastolic blood pressures (DBP) were recorded before induction, after induction, before intubation, 30 seconds, 1 minute, 2 minutes, 4 minutes, 6 minutes, and 10 minutes after intubation. After intubation HR and SBP increased significantly in group A (86.7 beats/min, 166.6 mmHg) in comparison with groups C (77.6 beats/min, 153.9 mmHg) and D (73.4 beats/min, 153.4 mmHg) (p < 0.05). Tachycardia (HR > 100) was found in 13 of 50(26%) patients in group A, 10 of 50(20%) patients in group B, 7 of 50(14%) patients in group C and 2 of 50(4%) patients in group D. Hypertension (SBP > 180) was found in 18(36%) patients in group A, 19(38%) patients in group B, 9(18%) patients in group C, and 6(12%) patients in group D. When compared with group A, only group D had significantly lower incidence of these adverse events (p < 0.05). In conclusion, fentanyl 5 micrograms/kg could not completely prevent the hemodynamic changes associated with endotracheal intubation, and 60 mg esmolol was observed to have positive effect in helping to control these changes.
authors.affiliation: Department of Anesthesiology, Cathay General Hospital, Taipei, R.O.C.
authors.forename: S C
authors.initials: SC
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Wu
authors.forename: M S
authors.initials: MS
authors.lastname: Lin
authors.forename: C F
authors.initials: CF
authors.lastname: Chang
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol