Esmolol

Background: The importance of decreasing bleeding in spine surgery is not only important to maintain the patient's hemody-namic balance but also allow a better view of the surgical field. Objectives: The current study aimed to compare dexmedetomidine and Esmolol™ as agents to induce hypotension in lumbar spine surgeries. Patients and Methods: A total of 50 patients aged 20 to 65 years belonging to the American society of anaesthesiologist (ASA) class I-II scheduled for decompression and fixation of the lumbar spine were included and divided into two groups namely, Group I, who received Esmolol and group II, who received dexmedetomidine, intravenously. The patients were compared for intraoperative hemodynamic parameters, estimated blood loss, operation time, intraoperative analgesic (fentanyl) consumption, and total fall in haemoglobin (Hb) during the perioperative period.

The suppression of neurovegetative response to laryngoscopy and intubation has been tried out using several pharmacological agents, such as opioids, local anaesthetics, β-blockers and α2 agonists. Gabapentin an anticonvulsant, while esmolol is a cardioselective β1 blocker and a class II antiarrhythmic, they have shown to attenuate pressor response to direct laryngoscopy and tracheal intubation individually. Given these variable characteristics of two drugs, the present study, a prospective randomized double blind aimed to compare their efficacy against haemodynamic response during intubation and laryngoscopy.

Abstract: In this review we want to summarize the results of the placebo-controlled randomized clinical trials with beta-blocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardio-vascular variables. We searched for studies in the electronic databases Medline. Keywords combined in the search were: “beta-adrenergic blocking agents ” and “electroconvulsive therapy”. The only limitation specified in the search was that the publications should include only randomized controlled trials. Esmolol and other beta-blocking adrenergic agents can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent. Therefore routine administration is not recom-mended. Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and an...

β-blockers like labetalol and esmolol have been successfully used for controlling acute autonomic responses during surgery. Objective: To compare the intraoperative use of labetalol and esmolol to fentanyl for maintaining hemodynamic stability during laparoscopic surgery and assess their effects on recovery profiles. Methods: 75 patients were randomly assigned to receive one of three different adjunctive treatments regimens. Immediately prior to induction of anesthesia, 1 mL of the unlabeled study medication (fentanyl [50µg/mL], or labetalol [5mg/mL], or esmolol [10 mg/mL]) was administered. A second 1mL dose of the same study medication was administered immediately before skin incision and subsequently as needed ['rescue'] during the surgical procedure to maintain heart rate (HR) and mean arterial pressure within 15% of the pre-induction baseline values. Results: The labetalol and esmolol groups had similar intraoperative HR and MAP values compared to the fentanyl group (p=0.4 and p=0.1 respectively). Fewer patients in the labetalol group required intraoperative rescue medications compared to the esmolol and fentanyl groups (p=0.0003). There were no significant differences in the requirement for parenteral opioid medication in the early postoperative period among the three groups. Of the post-discharge recovery outcomes studied, only incidence of 'low appetite' differed among the three groups, favoring the labetalol group over the fentanyl group (p=0.05). Labetalol was also less costly than both esmolol and fentanyl. Conclusion: Labetalol and esmolol were found to be comparable to fentanyl for maintaining hemodynamic stability during laparoscopic surgery. However, labetalol required less intraoperative rescue medication and had less adverse effect on appetite in the post-discharge period. Main Points  Beta-blockers can control acute autonomic responses during surgery  Beta-blockers can be used as alternatives to opioids during surgery  Labetalol is a cost-effective alternative to both esmolol and fentanyl