Optimal dose of esmolol in combination with nicardipine to stabilize cardiovascular response during anesthetic induction in ambulatory patients

Joo, Jin; Lee, Jaemin; Kim, Jeong Eun; Park, Jihye

Clinical Research

Anesthetic Pharmacology

Anesthesia and Pain Medicine 2010;5(4):288-294.
Published online October 31, 2010.

Optimal dose of esmolol in combination with nicardipine to stabilize cardiovascular response during anesthetic induction in ambulatory patients

Jin Joo, Jaemin Lee, Jeong Eun Kim, Jihye Park

Department of Anesthesiology and Pain Medicine, Seoul Saint Mary's Hospital, The Catholic University of Korea, Seoul, Korea. jmlee@catholic.ac.kr

Abstract

BACKGROUND
We conducted this study to determine the optimal dose of esmolol in combination with nicardipine to block undesirable cardiovascular responses effectively during endotracheal intubation in patients undergoing ambulatory surgery.
METHODS
One-hundred and twenty patients were randomly allocated into one of the following 4 groups: the E0 group (no esmolol, control), the E0.25 group (esmolol 0.25 mg/kg), the E0.5 group (esmolol 0.5 mg/kg) and the E1.0 group (esmolol 1.0 mg/kg). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9mg/kg. All the patients received 20 microgram/kg of nicardipine, and esmolol was subsequently administered according to the group. Endotracheal intubation was performed 150 seconds after inhalation of 6 vol% of desflurane. The systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure and the heart rate (HR) were measured before and immediately after intubation, and at 1, 3, 5, and 10 minutes after intubation. The rate changes were calculated using the baseline values as the standard (change rate [%] = measured value/baseline value x 100).
RESULTS
There were no significant differences in SBP, DBP and MBP after intubation between the control and the experimental groups. The rate changes of HR in the experimental groups were significantly lower than those in the control group throughout the study period (P < 0.05). However, there was no difference in therate changes of HR among the experimental groups.
CONCLUSIONS
The combination of nicardipine 20 microgram/kg and esmolol 0.25 mg/kg can most effectively and safely attenuate thecardiovascular responses during anesthetic induction in ambulatory patients.

Key Words: Ambulatory surgery, Anesthetic induction, Esmolol, Nicardipine, Tachycardia