The effect of a continuous infusion of low-dose esmolol on the requirement for remifentanil during laparoscopic gynecologic surgery

• Published in: Journal of clinical anesthesia 2013-02, Vol.25 (1), p.36-41
• Main Authors: Hwang, Won-Jung, MD, Moon, Young-Eun, MD, Cho, Sun-Jin, MD, Lee, Jaemin, MD
• Format: Article
• Language: English
• Subjects: Adrenergic beta-1 Receptor Antagonists - administration & dosage; Adult; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia & Perioperative Care; Anesthetics, Intravenous - administration & dosage; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Cardiac arrhythmia; Double-Blind Method; Drug Administration Schedule; Drug dosages; Esmolol; Female; Gynecologic Surgical Procedures; Heart rate; Humans; Infusions, Intravenous; Intraoperative; Intubation; Laparoscopy; Medical sciences; Middle Aged; Narcotics; Neuropharmacology; Opioid-sparing effect; Pain; Pain Medicine; Pain, Postoperative - prevention & control; Patients; Pharmacology. Drug treatments; Piperidines - administration & dosage; Postoperative Care - methods; Propanolamines - administration & dosage; Remifentanil; Surgery; Young Adult
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2012.06.005

Abstract Study Objective To investigate whether a continuous infusion of low-dose esmolol results in an opioid-sparing effect during surgery. Design Randomized, double-blinded, placebo-controlled clinical comparison study. Setting Operating room of a university hospital. Patients 56 ASA physical status 1 and 2 patients, aged 20 to 60 years, undergoing laparoscopic gynecologic surgery of less than two hours’ duration. Interventions The esmolol group (n = 28) received a 0.5 mg/kg loading dose of esmolol followed by an infusion of esmolol 30 μg/kg/min; the saline group (n = 28) received equivalent volumes of normal saline. Measurements The effect-site concentration of remifentanil (ng/mL) to maintain adequate anesthetic depth before infusion of the study drug (before-concentration) was measured. During infusion of study drug, the effect-site concentration of remifentanil was adjusted every 5 minutes to maintain systolic blood pressure within 15% of baseline and a Bispectral Index value between 50–60. The average of these adjusted concentrations (after-concentration) was measured and compared to the before-concentration. The quality of postoperative recovery was assessed. Main Results In the esmolol group, the after-concentration of remifentanil was decreased by 33.3% compared with the before-concentration. The total dose of remifentanil infused was also lower in the esmolol group (0.09 ± 0.1 vs 0.14 ± 0.03 μg/kg/min; P = 0.031). The esmolol group had lower scores on a pain numerical rating scale and required less fentanyl in the Postanesthesia Care Unit. Conclusions Intraoperative esmolol infusion decreases both the requirement for remifentanil and postoperative administration of rescue analgesics.