Esmolol prevents movement and attenuates the BIS response to orotracheal intubation.
BACKGROUND
Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting beta(1)-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation.


METHODS
Fifty patients were randomly allocated, in a double-blind fashion, to receive esmolol 1 mg kg(-1) followed by 250 micro g kg(-1) min(-1) or saline (control). Esmolol or saline was started 6 min after a target-controlled infusion (TCI) of propofol (effect-site concentration 4 micro g ml(-1)). After loss of consciousness, and before administration of vecuronium 0.1 mg kg(-1), a tourniquet was applied to one arm and inflated to 150 mm Hg greater than systolic pressure. Eleven minutes after the TCI began, the trachea was intubated; gross movement within the first min after orotracheal intubation was recorded. BIS was recorded at 10-s intervals. Mean arterial pressure (MAP) and heart rate were measured non-invasively every min.


RESULTS
There were no intergroup differences in BIS, heart rate or MAP before laryngoscopy. BIS increased significantly after orotracheal intubation (compared with the pre-laryngoscopy values) in the control group only, with a maximum increase of 40 (SD 18)% vs 8 (11)% in the esmolol group (P<0.01). Maximum changes in heart rate [45 (19)% vs 23 (14)%] and MAP [62 (24)% vs 45 (23)%] with orotracheal intubation were also significantly greater in the control group than in the esmolol group. More patients in the control than in the esmolol group moved after orotracheal intubation (23 vs 12, P<0.01).


CONCLUSIONS
Esmolol not only attenuated haemodynamic and somatic responses to laryngoscopy and orotracheal intubation, but also prevented BIS arousal reactions in patients anaesthetized with propofol.
Menigaux
C
C
Département d'Anesthésie-Réanimation, Ambroise Pare Hôpital, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France.
Guignard
B
B
Adam
F
F
Sessler
D I
DI
Joly
V
V
Chauvin
M
M
D000759:Adjuvants, Anesthesia / Q000494:pharmacology*; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000758:Anesthesia / Q000379:methods; D001143:Arousal / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007440:Intubation / Q000379:methods*; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009068:Movement / Q000187:drug effects*; D011412:Propanolamines / Q000494:pharmacology*
D000759:Adjuvants, Anesthesia; D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol