Faculty Collaboration Database

Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth 1990;2(4):243-52

Date

07/01/1990

Pubmed ID

1975189

DOI

10.1016/0952-8180(90)90104-b

Scopus ID

2-s2.0-0025645969 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

The effectiveness of a single preinduction intravenous (IV) bolus of esmolol in blunting hemodynamic responses to rapid sequence induction and tracheal intubation was evaluated. In a randomized double-blind study, 32 ASA I and II healthy patients scheduled for surgery were monitored with electrocardiography (EKG) lead V5, arterial cannulation, and impedance cardiography. After preoxygenation and a priming dose of vecuronium (0.01 mg/kg), patients received either saline (n = 12), esmolol 100 mg (n = 10), or esmolol 200 mg (n = 10) as an IV bolus (20 ml volume). This procedure was immediately followed by a 5 ml IV saline flush, cricoid pressure, thiopental sodium 5 mg/kg, and succinylcholine 1.5 mg/kg. Patients receiving 200 mg of esmolol had a 50% reduction in the usual tachycardia associated with induction and a greater decline in systolic blood pressure (SP) (by 50%) prior to intubation as compared with the placebo group (p less than 0.05). The increase in diastolic blood pressure (DP) and the reduction in stroke volume (SV) produced by induction and intubation were similar in all the groups. Plasma norepinephrine levels at 1.5 minutes after intubation increased in the esmolol groups about 130% above that measured in the placebo group. This finding was associated with a more gradual return of peripheral resistance to baseline following tracheal intubation. However, both doses of esmolol effectively attenuated heart rate (HR), SP, and rate pressure product (RPP) increases (p less than 0.05 vs placebo) produced by laryngoscopy and tracheal intubation.

Author List

Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP

Authors

Thomas J. Ebert MD Adjunct Professor in the Anesthesiology department at Medical College of Wisconsin
David F. Stowe PhD, MA, MA Emeritus Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Adult
Anesthesia, General
Blood Pressure
Cardiac Output
Double-Blind Method
Heart Rate
Hemodynamics
Humans
Injections, Intravenous
Intubation, Intratracheal
Laryngoscopy
Middle Aged
Placebos
Propanolamines
Random Allocation
Stroke Volume
Time Factors
Vascular Resistance