Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery.
BACKGROUND
Carbon dioxide (CO2) pneumoperitoneum for laparoscopic surgery increases arterial pressures, systemic vascular resistance and heart rate and decreases urine output.


METHODS
In this double-blind randomized study esmolol, an ultrashort-acting beta1-adrenoceptor antagonist was compared with physiological saline (control) in 28 patients undergoing laparoscopic surgery in standardized 1 MAC isoflurane anaesthesia. Alfentanil infusion was used to prevent the increase of mean arterial pressure more than 25% from baseline.


RESULTS
Esmolol effectively prevented the pressor response to induction and maintenance of CO2 pneumoperitoneum. Significantly (P<0.001) less alfentanil was needed in the esmolol group than in the control group. Urine output was higher (P<0.05) and plasma renin activity (P<0.01) and urine N-acetyl-beta-D-glucosaminidase levels lower in the esmolol group when compared with the control group.


CONCLUSIONS
Esmolol blunts the pressor response to induction and maintenance of pneumoperitoneum and may protect against renal ischaemia during pneumoperitoneum.
Koivusalo
A M
AM
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Scheinin
M
M
Tikkanen
I
I
Yli-Suomu
T
T
Ristkari
S
S
Laakso
J
J
Lindgren
L
L
D000118:Acetylglucosaminidase / Q000652:urine; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D007530:Isoflurane / Q000008:administration & dosage; D007668:Kidney / Q000098:blood supply; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D012083:Renin / Q000097:blood; D012965:Sodium Chloride; D014556:Urine; D014655:Vascular Resistance / Q000187:drug effects
D000318:Adrenergic beta-Agonists; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D011412:Propanolamines; D002245:Carbon Dioxide; D015760:Alfentanil; D012965:Sodium Chloride; D007530:Isoflurane; D000118:Acetylglucosaminidase; D012083:Renin; C036604:esmolol