Cardiac arrest after esmolol administration: a review of acute beta-blocker toxicity.
An 11-year-old, 25-kg girl with congenital myelomeningocele was scheduled for posterior spinal fusion because of progressive scoliosis. After induction of general anesthesia and administration of a standard dose of intravenous esmolol hydrochloride, her cardiac rhythm progressed to asystole. Although given ephedrine, epinephrine, and atropine sulfate, the patient's normal heart rhythm could not be restored until calcium chloride was administered. A review of the medical literature indicates that the optimal treatment for acute beta-blocker toxicity is intravenous glucagon. Calcium administration should also be considered. Acute esmolol toxicity may be self-limiting because of its extremely short half-life.
Litman
R S
RS
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY, USA. rlitman@ccmail.anes.rochester.edu
Zerngast
B A
BA
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000758:Anesthesia / Q000009:adverse effects; D002122:Calcium Chloride / Q000627:therapeutic use; D002648:Child; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008591:Meningomyelocele / Q000601:surgery; D011412:Propanolamines / Q000009:adverse effects* / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; D002122:Calcium Chloride; C036604:esmolol