The safety and efficacy of esmolol during myocardial revascularization

• Published in: Anesthesiology (Philadelphia) 1986-08, Vol.65 (2), p.157-164
• Main Authors: GIRARD, D, SHULMAN, B. J, THYS, D. M, MINDICH, B. P, MIKULA, S. K, KAPLAN, J. A
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure - drug effects; Cardiac Output - drug effects; Clinical Trials as Topic; Coronary Artery Bypass; Double-Blind Method; Female; Fentanyl; Heart Rate - drug effects; Hemodynamics - drug effects; Humans; Kinetics; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Propanolamines - therapeutic use; Pulmonary Wedge Pressure - drug effects; Stroke Volume - drug effects; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Vascular Resistance - drug effects
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-198608000-00005

The safety and efficacy of esmolol during high-dose fentanyl anesthesia were studied in 37 patients undergoing coronary artery bypass grafting (CABG). The anesthetic management consisted of fentanyl 75 micrograms/kg, pancuronium 0.15 mg/kg, and O2. To assess the safety of esmolol, it was administered in a double-blind manner to 17 anesthetized patients prior to surgical incision. Infusion of the drug was increased in stepwise fashion to obtain administration rates between 100 and 300 micrograms X kg-1 X min-1. Esmolol produced small but significant increases in pulmonary capillary wedge pressure (PCWP) (8.3 +/- 1.7 to 13.2 +/- 2.0 mmHg) when compared with placebo (10.9 +/- 1.0 to 12.1 +/- 0.6 mmHg) (P less than 0.05). For the other studied parameters (heart rate, mean arterial pressure, central venous pressure, cardiac index, stroke index, left ventricular stroke work index, systemic vascular resistance, and peripheral vascular resistance), no significant differences were observed between esmolol and placebo. To evaluate the efficacy of esmolol, 20 patients were randomly assigned to an esmolol group (n = 11) or a placebo group (n = 9). The study medication was infused from 5 min before induction through initiation of cardiopulmonary bypass. Infusion of esmolol at 200 micrograms X kg-1 X min-1 prevented tachycardia in response to intubation. In the esmolol group the heart rate increased from 63.4 +/- 2.7 to 67.6 +/- 2.9 beats/min after intubation, while in the placebo group it increased from 61.4 +/- 4.3 to 72.4 +/- 3.4 beats/min (P less than 0.05).