Abstract
Esmolol, an ultra-short-acting cardioselective betaadrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12-minute infusion of esmolol (500 µg·kg-1·min-1 for four minutes, then 300 µg·kg-1 min-1 for 8 mnutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg·kg-1 thiopentone followed by succinylcholine for tracheal intubation. Prior to induction esmolol produced significant decreases in heart rate (HR) (9.3 ± 1.8 per cent) and rate-pressure product (RPP) (13.1 ± 1.8 per cent), systolic blood pressure (SAP) (4.3 ± 1.5 per cent) and mean arterial blood pressure (MAP) (1.7 ± 2.0 per cent). Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR (p < 0.0001), and RPP (p < 0.0005) and significant differences in SAP (p < 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.
Résumé
L’esmolol, un bloquer bêta-adrénergique cardiosélectif de courte durée d’action a été investigué dans une étude prospective à double insu pour sa capacité de contrôler les réponses hémodynamiques associées à l’intubation trachéale après thiopentone et succinylcholine. Trente patients ASA I ont requ une perfusion de 12 minutes d’esmolol (500 µg ·kg-1· min-1 pour quatre minutes, puis 300 µg ·kg-1 pour huit minutes) ou du salin. Cinq minutes après le début de la perfusion du médicament ou du placebo, l’ anesthésie était induite avec 4 mg·kg-1 de thiopentone suivi de succinylcholine pour l’intubation trachéale. Avant l’induction l’esmolol a produit une diminution significative de la fréquence cardiaque (HR) (9.3 ± 1.8 pour cent) et du produit fréquence-pression (RPP) (13.1 ±1.8 pour cent), de la tension artérielle systolique (SAP) (4.3 ± 1.5 pour cent) et de la pression artérielle mopenne (MAP) (1.7 ± 2.0 pour cent). Après l’intubation, l’augmentation dans la fréquence cardiaque, la pression artérielle systolique et la produit fréquence-pression était approximativement 50 pour cent moindre chez les patients ayant reçu de l’esmolol que chez les patients ayant regu du placebo. Il y avait une difference hautement significative dans la frequence cardiaque (p < 0.0001) et dans le produit fréquencepression (p < 0.0005) ainsi qu’une difference significative dans la pression artérielle systolique (p < 0.05) quand la réponse maximale post-intubation à l’esmolol a été comparée à la réponse maximale au placebo. La perfusion d’esmolol aux doses utilisées dans cette étude atténue significativement mais n’élimine pas complètement les réponses cardiovasculaires à l’intubation.
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This investigation was supported by a grant from American Critical Care, McGaw Park, Illinois.
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Liu, P.L., Gatt, S., Gugino, L.D. et al. Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine. Can Anaesth Soc J 33, 556–562 (1986). https://doi.org/10.1007/BF03014260
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DOI: https://doi.org/10.1007/BF03014260