Esmolol

Abstract: Background—Electrical storm (ES), defined as recurrent multiple ventricular fibrillation (VF) episodes, often occurs in patients with recent myocardial infarction. Because treating ES according to the Advanced Cardiac Life Support (ACLS) guidelines yields a poor outcome, we evaluated the efficacy of sympathetic blockade in treating ES patients and compared their outcome with that of patients treated according to the ACLS guidelines. Methods and Results—Forty-nine patients (36 men, 13 women, mean age 57±10 years) who had ES associated with a recent myocardial infarction were separated into 2 groups. Patients in group 1 (n=27) received sympathetic blockade treatment: 6 left stellate ganglionic blockade, 7 esmolol, and 14 propranolol. Patients in group 2 (n=22) received antiarrhythmic medication as recommended by the ACLS guidelines. Patient characteristics were similar in the 2 groups. The 1-week mortality rate was higher in group 2: 18 (82%) of the 22 patients died, all of refractory VF; 6 (22%) of the 27 ...

Abstract: The purpose of this study was to compare surgical conditions for functional endoscopic sinus surgery (FESS) under general anaesthesia during controlled induced hypotension, using either sodium nitroprusside (SNP) or esmolol. Twenty patients, assigned to receive either of the drugs as the primary hypotensive agent, were studied. The same surgeon, blinded to the hypotensive agent used and the haemodynamic variables, performed all the operations. The surgeon used a category scale (0-5) to assess surgical conditions--a value of 2-3 being ideal. Patients were positioned in 5 degrees reverse Trendelenburg position and the mean arterial blood pressure (MABP) was reduced in steps of 5 mmHg. The anaesthetist prompted category scale estimations by the surgeon following a change in any of the haemodynamic variables. Average category scale (ACS) values were compared between the two groups for four data groups, i.e., MABP > 65 mmHg (mild), 60-64 mmHg, 55-59 mmHg and 50-54 mmHg. Pre-treatment MABP was 79.8 +/- 10.4 mmHg in the SNP group and 76.1 +/- 6.8 mmHg in the esmolol group. At mild SNP-induced hypotension, surgical conditions were poor (ACS = 3.63 +/- 0.22; mean +/- SEM), while in the esmolol group, ideal surgical conditions (ACS = 2.94 +/- 0.34) were recorded at MABP > 65 mmHg. The combined effects of increased venous drainage due to the reverse Trendelenburg position, hypotension as well as capillary vasoconstriction due to unopposed alpha-adrenergic effect on the mucous membrane vasculature in the esmolol group (as opposed to vasodilatation in the SNP group) probably caused the superior surgical conditions.

Abstract: The effects of esmolol, an ultrashort-acting β blocker, and verapamil were compared in controlling ventricular response in 45 patients with atrial fibrillation or atrial flutter, in a randomized, parallel, open-label study. Patients with either new onset ( 48 hours, n = 14) of atrial fibrillation or flutter with rapid ventricular rate were stratified to receive esmolol (n = 21) or verapamil (n = 24). Drug efficacy was measured by ventricular rate reduction and conversion to sinus rhythm. The heart rate declined with esmolol from 139 to 100 beats/min (p < 0.001) and with verapamil from 142 to 97 beats/min (p < 0.001). Fifty percent of esmolol-treated patients with new onset of arrhythmias converted to sinus rhythm, whereas only 12% of those who received verapamil converted (p < 0.03). Mild hypotension was observed in both treatment groups. Esmolol compares favorably with verapamil with respect to both efficacy and safety in acutely decreasing ventricular response during atrial fibrillation or flutter. Moreover, conversion to sinus rhythm is significantly more likely with esmolol.

Abstract: Purpose: To determine whether remifentanil, combined with propofol, could induce controlled hypotension, reduce middle ear blood flow (MEBF) measured by laser-Doppler flowmetry, provide a “dry” operative field, and could be compared with nitroprusside or esmolol combined with alfentanil and propofol.