This double-blind, randomized, placebocontrolled study evaluated the sparing effect of esmolol on sevoflurane during laparoscopic gynaecological surgery in 54 patients between December 2009 and May 2010. The concentration of sevoflurane required to maintain adequate anaesthesia was determined. Patients received either a 0.5 mg/kg esmolol intravenous loading dose followed by infusion of 30 μg/kg per min or an identical volume of normal saline (placebo). During surgery the input concentration of sevoflurane was adjusted every 5 min to maintain systolic blood pressure within 15% of baseline and bispectral index at 50–60. Infusion of esmolol resulted in an 18.2% decrease in mean sevoflurane input concentration. Patients receiving esmolol had an earlier discharge from the postanaesthetic care unit and a lower mean fentanyl dose. In conclusion, intraoperative esmolol infusion decreased both the requirement for sevoflurane and postoperative administration of fentanyl.
PagelPSNijhawanNWarltierDC: Quantitation of volatile anesthetic-induced depression of myocardial contractility using a single beat index derived from maximal ventricular power. J Cardiothorac Vasc Anesth1993; 7: 688–695.
2.
NicholauD: The postanesthesia care unit. In: Miller's Anesthesia (MillerRD, ed). Philadelphia: Churchill Livingstone, 2007; pp 2707–2728.
3.
BerthoudMCReillyCS: Adverse effects of general anaesthetics. Drug Saf1992; 7: 434–459.
4.
ColomaMChiuJWWhitePF: The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg2001; 92: 352–357.
5.
JohansenJWFlaishonRSebelPS: Esmolol reduces anaesthetic requirement for skin incision during propofol/nitrous oxide/morphine anesthesia. Anesthesiology1997; 86: 364–371.
6.
OzturkTKayaHAranG: Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy. Br J Anaesth2008; 100: 211–214.
7.
MenigauxCGuignardBAdamF: Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth2002; 89: 857–862.
8.
OdaYNishikawaKHaseI: The short-acting betal-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane anesthesia. Anesth Analg2005; 100: 733–737.
9.
ChoiSHKimCSKimJH: A single dose of esmolol blunts the increase in bispectral index to tracheal intubation during sevoflurane but not desflurane anesthesia. J Neurosurg Anesthesiol2009; 21: 214–217.
10.
DavidsonEMDoursoutMFSzmukP: Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats. Can J Anaesth2001; 48: 59–64.
11.
ZhaoHSugawaraTMiuraS: Intrathecal landiolol inhibits nociception and spinal c-Fos expression in the mouse formalin test. Can J Anaesth2007; 54: 201–207.
WhitePFSongD: New criteria for fast-tracking after outpatient anesthesia: A comparison with the modified Aldrete's scoring system. Anesth Analg1999; 88: 1069–1072.
14.
CollardVMistralettiGTaqiA: Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg2007; 105: 1255–1262.
15.
StanleyTHde LangeSBoscoeMJ: The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease. Can Anaesth Soc J1982; 29: 319–324.
16.
SmithIVan HemelrijckJWhitePF: Efficacy of esmolol versus alfentanil as a supplement to propofol-nitrous oxide anesthesia. Anesth Analg1991; 73: 540–546.
17.
ChiaYYChanMHKoNH: Role of β-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth2004; 93: 799–805.
18.
LiuJSinghHWhitePF: Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology1996; 84: 64–69.
19.
LiuJSinghHWhitePF: Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg1997; 84: 185–189.
20.
MiWDSakaiTTakahashiS: Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth1998; 45: 19–22.
21.
JohansenJWSchneiderGWindsorAM: Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil. Anesth Analg1998; 87: 671–676.
22.
LeeSCKimHKHamBM: The effect of intravenous esmolol on endotracheal intubation. Korean J Anesthesiol1993; 26: 63–71.
23.
WhitePFWangBTangJ: The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesth Analg2003; 97: 1633–1638.
24.
ZauggMTaglienteTLucchinettiE: Beneficial effects from β-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology1999; 91: 1674–1686.
25.
MasakiE: Antinociceptive effects of landiolol and esmolol. Masui2006; 55: 849–855 [in Japanese, English abstract].
26.
SarveyJMBurgardECDeckerG: Long-term potentiation: studies in the hippocampal slice. J Neurosci Methods1989; 28: 109–124.
27.
SumCYYacobiAKartzinelR: Kinetics of esmolol, an ultra-short-acting β-blocker, and of its major metabolite. Clin Pharmacol Ther1983; 34: 427–434.
28.
HagelukenAGrunbaumLNurnbergB: Lipophilic β-adrenoceptor antagonists and local anesthetics are effective direct activators of G-proteins. Biochem Pharmacol1994; 47: 1789–1795.
29.
MitrovicIMargeta-MitrovicMBaderS: Contribution of GIRK2-mediated postsynaptic signaling to opiate and α2-adrenergic analgesia and analgesic sex differences. Proc Natl Acad Sci U S A2003; 100: 271–276.
30.
AvramMJKrejcieTCHenthornTK: β-Adrenergic blockade affects initial drug distribution due to decreased cardiac output and altered blood flow distribution. J Pharmacol Exp Ther2004; 311: 617–624.
31.
KimYH: The antinociceptive effect of esmolol. Korean J Anesthesiol2010; 59: 141–143.
32.
EberhartLHMauchMMorinAM: Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting. Anaesthesia2002; 57: 1022–1027.
33.
GanTJ: Risk factors for postoperative nausea and vomiting. Anesth Analg2006; 102: 1884–1898.
