Effects of landiolol, a short-acting beta-1 blocker, on hemodynamic variables during emergence from anesthesia and tracheal extubation in elderly patients with and without hypertension

• Published in: Journal of anesthesia 2009-11, Vol.23 (4), p.483-488
• Main Authors: Miyazaki, Masumi, Kadoi, Yuji, Saito, Shigeru
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - pharmacology; Adrenergic beta-Antagonists - therapeutic use; Aged; Anesthesia Recovery Period; Anesthesiology; Blood Pressure - drug effects; Critical Care Medicine; Electroencephalography; Emergency Medicine; Female; Gynecologic Surgical Procedures; Heart Rate - drug effects; Hemodynamics - drug effects; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Intensive; Intubation, Intratracheal; Male; Medicine; Medicine & Public Health; Monitoring, Intraoperative; Morpholines - pharmacology; Morpholines - therapeutic use; Original Article; Orthopedic Procedures; Pain Medicine; Urea - analogs & derivatives; Urea - pharmacology; Urea - therapeutic use
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-009-0805-9

Purpose Tracheal extubation and emergence procedures induce abrupt changes in hemodynamics and humoral responses. We conducted a prospective randomized study to examine the effects of the short-acting beta-1 blocker, landiolol, on hemodynamics during emergence from anesthesia in elderly patients with and without hypertension. Methods Thirty-one hypertensive and 32 normotensive elderly patients were randomly divided into two groups: a control (placebo group) and a landiolol infusion group. Landiolol was dissolved in 20 ml of saline and administered as an infusion at the rate of 0.125 mg·kg −1 ·min −1 for 1 min and then decreased to 0.04 mg·kg −1 ·min −1 until extubation. Control patients received an equal volume of saline. Heart rate and blood pressure were recorded every minute from immediately before the administration of landiolol up to the discontinuation of landiolol, and every 5 min from the discontinuation of landiolol to 30 min after termination of the infusion. Results Systolic blood pressure in the control group patients with hypertension increased during anesthesia emergence and tracheal extubation, as did the heart rate. Landiolol infusion in the elderly patients with hypertension partially prevented the increase in systolic blood pressure and completely prevented the increase in heart rate associated with emergence from anesthesia. Landiolol infusion in the elderly patients without hypertension brought about a decrease in heart rate during emergence and tracheal extubation. Conclusion This study indicates that the use of a landiolol infusion for preventing hemodynamic instability in elderly patients during the emergence period would be dependent on the presence or absence of hypertension in these patients.