title: The optimal dose of esmolol and nicardipine for maintaining cardiovascular stability during rapid-sequence induction.
abstract: OBJECTIVE
  To determine the optimal dose of esmolol in combination with nicardipine in effectively blocking undesirable cardiovascular responses during rapid-sequence induction.
  
  
  METHODS
  Prospective, randomized clinical comparison study.
  
  
  METHODS
  Operating room of a university hospital.
  
  
  METHODS
  200 ASA physical status 1 and 2 patients requiring general anesthesia with endotracheal tube placement.
  
  
  METHODS
  Patients were randomly allocated into one of 4 groups: Group E0 (no esmolol; control), Group E0.25 (esmolol 0.25 mg/kg), Group E0.5 (esmolol 0.5 mg/kg), and Group E1.0 (esmolol 1.0 mg/kg). All patients received 20 μg/kg of nicardipine, and esmolol was then given according to group allocation. Ninety seconds later, thiopental sodium 5 mg/kg and succinylcholine 1.0 mg/kg were injected. Endotracheal intubation was performed 60 seconds after injection of the anesthetic agents.
  
  
  METHODS
  Systolic (SBP), diastolic (DBP), and mean arterial (MAP) pressures; heart rate (HR), and rate-pressure product (RPP) were measured 30 seconds before and after intubation, and at 1, 3, 5, and 10 minutes after intubation. Rate changes using baseline values as the standard [rate changes = measured value/baseline value × 100 (%)] were calculated.
  
  
  RESULTS
  Significant attenuations in SBP, MAP, HR, and RPP after intubation were noted in the experimental groups as compared with the control group (P < 0.05). Rate changes in HR in Groups E0.5 and E1.0 were significantly lower than those in Group E0.25 immediately and one minute after intubation (P < 0.05). No difference in rate changes in HR were noted between the E0.5 and E1.0 groups.
  
  
  CONCLUSIONS
  The combination of nicardipine 20 μg/kg and esmolol 0.5 mg/kg most effectively attenuates the cardiovascular responses during rapid-sequence induction.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Catholic Medical College, Seoul 504, South Korea.
authors.forename: Young-Eun
authors.initials: YE
authors.lastname: Moon
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Jaemin
authors.initials: J
authors.lastname: Lee
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D000328:Adult; D018681:Anesthetics, General / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage / Q000494:pharmacology*; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D018681:Anesthetics, General; D002121:Calcium Channel Blockers; D011412:Propanolamines; D009529:Nicardipine; C036604:esmolol