title: Efficacy of landiolol in attenuating hemodynamic responses to local epinephrine infiltration in patients undergoing vaginal total hysterectomy.
abstract: OBJECTIVE
  Local epinephrine infiltration often causes beta1-adrenoceptor-mediated tachycardia, hypertension, and arrhythmia. Landiolol, a short acting beta1-adrenoceptor blocker, may represent the most ideal agent to attenuate these adverse effects. In this study, we examined the effects of landiolol on the hemodynamic changes resulting from local infiltration of epinephrine.
  
  
  METHODS
  Thirty-six patients undergoing vaginal total hysterectomy under general anesthesia were randomly assigned to one of three groups: control group (n = 12), L5 group (n = 12), and L10 group (n = 12). In the control, L5, and L10 groups, the patients were given saline, landiolol 5 mg, and 10 mg, respectively, just before infiltration of epinephrine(1 : 300,000; total dose, about 100 microg) into the surgical field. Blood pressure and heart rate was assessed before and 5, 10, 15, 20, 25, 30 min after the initiation of epinephrine infiltration. If systolic blood pressure and heart rate exceeded 160 mmHg and 120 beats.min(-1), respectively, Ca blockers of either diltiazem 5 mg or nicardipine 1 mg and/or 2% sevoflurane were given.
  
  
  RESULTS
  Epinephrine infiltration significantly increased systolic blood pressure from 122 +/- 15 to 170 +/- 29 mmHg and heart rate from 63 +/- 8 to 106 +/- 10 beats.min(-1). In both the L5 and L10 groups, the increase in heart rate (from 69 +/- 16 to 87 +/- 16 beats.min(-1), P < 0.01, and from 70 +/- 18 to 76 +/- 9 beats.min(-1), P < 0.01, respectively) was significantly smaller compared to the control group, but the increase in systolic blood pressure was significantly attenuated in the L10 group (from 116 +/- 18 to 140 +/- 27 mmHg, P < 0.01). The number of patients given either Ca blockers or sevoflurane in the control group was significantly higher than that in the landiolol groups (P < 0.01).
  
  
  CONCLUSIONS
  The present study suggests that landiolol 10 mg may be a more suitable dose than landiolol 5 mg to antagonize hyperdynamic states induced by local administration of epinephrine.
authors.affiliation: Department of Anesthesiology, University of Hirosaki School of Medicine, 53 Honcho, Hirosaki, 036-8563, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
authors.forename: Sachiko
authors.initials: S
authors.lastname: Baba
authors.forename: Sadao
authors.initials: S
authors.lastname: Fukushi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Muraoka
authors.forename: Akitomo
authors.initials: A
authors.lastname: Matsuki
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D004837:Epinephrine / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007045:Hysterectomy, Vaginal; D008875:Middle Aged; D009025:Morpholines / Q000494:pharmacology*; D014508:Urea / Q000031:analogs & derivatives* / Q000494:pharmacology*
chemical_list: D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea; D004837:Epinephrine