Canadian Journal of Anesthesia, Vol 33, 556-562, Copyright © 1986 by Canadian Anesthesiologists' Society

Esmolol for Control of Increases in Heart Rate and Blood Pressure During Tracheal Intubation After Thiopentone and Succinylcholine

¹ Department of Anaesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Address correspondence to: Dr. Philip L. Liu, Department of Anesthesia, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Esmolol, an ultra-short-acting cardioselective beta-adrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12 -minute infusion of esmolol (500 µg·kg^-1 ·min^-1 for four minutes, then 300 µ·kg^-1·min^-1 for 8 mnutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg·kg^-1 thiopentone followed by succinylcholine for tracheal intubation. Prior to induction esmolol produced significant decreases in heart rate (HR)(9.3 ± 1.8 per cent) and rate-pressure product (RPP)(13.1 ± 1.8 per cent), systolic blood pressure (SAP)(4.3 ±1.5 per cent) and mean arterial blood pressure (MAP)(1.7 ± 2.0 per cent). Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR(p < 0.0001), and RPP (p < 0.0005) and significant differences in SAP(p < 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.

Key Words: SYMPATHETIC NERVOUS SYSTEM: sympatholytic agents, esmolol • COMPLICATIONS: hypertension, tachycardia • INTUBATION, TRACHEAL: complications