The hemodynamic effects of landiolol, an ultra-short-acting beta1-selective blocker, on endotracheal intubation in patients with and without hypertension.
BACKGROUND
The ultra-short-acting beta1-selective blocker, landiolol, is widely used in Japan. We investigated the effects of landiolol on intubation-induced adrenergic response in 88 patients.


METHODS
General anesthesia was induced and maintained with target-controlled infusion of propofol at an effect-site concentration of 5 microg/mL. Muscle relaxation was obtained with 0.1 mg/kg vecuronium, and endotracheal intubation was performed 4 min after vecuronium injection. We first investigated the optimal time point for landiolol to be administered before intubation in 43 normotensive patients. Then we examined whether landiolol was as effective as fentanyl to prevent tachycardia after intubation in 45 hypertensive patients.


RESULTS
Landiolol at 0.1 mg/kg was most effective against intubation-induced tachycardia when infused 4 min before intubation in normotensive patients. However, 0.2 mg/kg landiolol was necessary to prevent tachycardia after intubation in hypertensive patients. Landiolol had no significant effects on arterial blood pressure or bispectral index at any dose throughout the study period. In contrast, 2 mug/kg fentanyl frequently caused hypotension just before and 5 min after intubation.


CONCLUSIONS
Low doses of landiolol can effectively prevent tachycardia after intubation without significant effects on arterial blood pressure.
Sugiura
Soichiro
S
Department of Anesthesiology and Perioperative Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan. s-sugi@kanazawa-med.ac.jp
Seki
Sumihiko
S
Hidaka
Kohji
K
Masuoka
Miharu
M
Tsuchida
Hideaki
H
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007022:Hypotension / Q000139:chemically induced; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D018342:Receptors, Adrenergic, beta-1 / Q000187:drug effects / Q000502:physiology*; D013610:Tachycardia / Q000517:prevention & control; D014508:Urea / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D009025:Morpholines; D018342:Receptors, Adrenergic, beta-1; C077049:landiolol; D014508:Urea; D005283:Fentanyl