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ESMOLOL AND THE HEMODYNMAIC RESPONSE TO CO₂ PNEUMOPERITONEUM

Département d'anesthésie, Hôpital Maisonneuve-Rosemont, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4

INTRODUCTION

Creation of CO₂ pneumoperitoneum may induce rapid and transient elevations in heart rate and arterial pressure^1-2. This study sought to evaluate the effect of a bolus of esmolol in blunting these hemodynamic changes.

METHODS

Following approval from our institutional review board and from each participants, sixty adults undergoing laparoscopic cholecystectomy were randomized in this double blind study. Anesthesia was induced with fentanyl 2 µg/kg IV, propofol 1-3 mg/kg IV and rocuronium 0.6 mg/kg IV, followed by a mixture of N₂O/O₂, propofol and rocuronium. Patients were allocated to one of three groups to receive, one minute before insufflation of pneumoperitoneum, a bolus of placebo (group 1), esmolol 0.25 mg/kg (group 2), or esmolol 0.5 mg/kg (group 3). Heart rate and non-invasive mean arterial blood pressure (MAP) were measured at the time of administration of the study solution, every minute for the next 10 minutes and every 2.5 minutes thereafter. Repeated measures ANOVA, followed by Dunnet's multiple comparison test was used for comparing data within groups, while two-way repeated measures ANOVA was used for comparisons between groups.

RESULTS

There was no difference between the groups with regard to heart rate (fig.1). Patients in group 1 and 2, but not in group 3, showed a slight but significant elevation of heart rate with the creation of the pneumoperitoneum when compared with their respective baseline measurements. There was no difference between the three groups for MAP, but all groups showed a transient elevation of MAP in the first minutes after CO₂ insufflation when compared to their baseline measurements (fig. 2).

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The creation of CO₂ pneumoperitoneum is associated with a transient elevation of MAP, wich was not affected by a single bolus of esmolol. It was also associated with a slight increase in heart rate that can be blunted by esmolol 0.5 mg/kg IV.

REFERENCE

1 Anesth Analg 1993;76: 1120-33.

2 Can J Anaesth 1995; 42: 51–63.[Abstract/Free Full Text]

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