Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers.
OBJECTIVE
Cigarette smokers constitute a group of patients with an increased hemodynamic response to tracheal intubation. We studied the dose-response and side effects of bolus administration of esmolol hydrochloride in cigarette smokers undergoing elective microlaryngeal surgery, when esmolol was used for reducing the intense hemodynamic response to laryngoscopy and tracheal intubation.


METHODS
We randomly allocated 165 patients (American Society of Anesthesiologists physical status classes I to III) to receive placebo (Eplac) or esmolol 1 mg/kg (E1) or 2 mg/kg (E2). The esmolol was given 2 minutes before laryngoscopy and tracheal intubation. The same anesthetic technique was used in all patients. Cardiovascular parameters were recorded every minute for the first 5 minutes and thereafter every 3 minutes. Bronchospasm, other side effects, and rescue esmolol treatment were noted during anesthesia.


RESULTS
In group Eplac, significant increases (p < .05) in arterial blood pressure and heart rate were observed in the first 3 minutes after tracheal intubation. In group E1, significant increases (p < .05) in diastolic blood pressure were observed in the first 2 minutes after intubation. In group E2, no significant fluctuations were recorded in cardiovascular parameters after intubation. During surgery, 17% of the patients in group Eplac showed an increase in blood pressure and tachycardia.


CONCLUSIONS
We conclude that esmolol administration of 2 mg/kg during induction of anesthesia in smokers provides hemodynamic stability after laryngoscopy and tracheal intubation with no severe side effects.
Louizos
Antonios A
AA
Department of Anesthesiology, Hippocration General Hospital, Athens, Greece.
Hadzilia
Sophie J
SJ
Davilis
Dimitrios I
DI
Samanta
Evangelia G
EG
Georgiou
Loucas G
LG
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D007818:Laryngeal Diseases / Q000503:physiopathology / Q000601:surgery*; D007828:Laryngoscopy; D008297:Male; D008866:Microsurgery / Q000379:methods*; D016343:Monitoring, Intraoperative; D011412:Propanolamines / Q000008:administration & dosage* / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol