Landiolol and esmolol prevent tachycardia without altering cerebral blood flow.
OBJECTIVE
Several ss-adrenergic-blocking drugs have been used during electroconvulsive therapy (ECT) to stabilize the hemodynamic alterations following electrical stimulation. The effects of two ultra-short acting ss-adrenergic-blocking drugs, esmolol and landiolol, on systemic and cerebral circulation were studied during ECT.


METHODS
In the first study (n = 15), dose-dependent hemodynamic changes were studied when landiolol was administered immediately after induction of anesthesia. In the second study (n = 12), effects of esmolol and landiolol on systemic and cerebral circulation were compared. Patients in Study 1 received three doses of landiolol, and patients in Study 2 received two types of ss-adrenergic-blocking drugs, in a randomized cross-over design in a series of ECT trials.


RESULTS
In the first study, 0.25 to 0.5 mg.kg(-1) landiolol induced a lower heart rate after the electrical stimulation compared to vehicle (P < 0.01). Landiolol did not have significant effects on blood pressure. In the second study, heart rate was stabilized by 1.0 mg.kg(-1) esmolol iv or 0.5 mg.kg(-1) landiolol iv. Increase in mean blood pressure was ameliorated by esmolol (P < 0.01), but not by landiolol. Mean cerebral blood flow velocity in the middle cerebral artery increased at one to two minutes after the electrical stimulation regardless of the use of ss-adrenergic-blocking drugs (P < 0.01). Muscular and electroencephalographic seizure durations were not significantly altered by the ss-adrenergic-blocking drugs.


CONCLUSIONS
Landiolol suppresses heart rate elevation during ECT without affecting blood pressure. Cerebral blood flow velocity in the middle cerebral artery is not affected by the use of either esmolol or landiolol.
Saito
Shigeru
S
Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi 371-8511, Japan. shigerus@showa.gunma-u.ac.jp
Nishihara
Fumio
F
Akihiro
Tomioka
T
Nishikawa
Koichi
K
Obata
Hideaki
H
Goto
Fumio
F
Yuki
Naoya
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D004565:Electroconvulsive Therapy; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D011412:Propanolamines / Q000627:therapeutic use*; D013610:Tachycardia / Q000517:prevention & control*; D017585:Ultrasonography, Doppler, Transcranial; D014508:Urea / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D009025:Morpholines; D011412:Propanolamines; C077049:landiolol; D014508:Urea; C036604:esmolol