Esmolol kao dodatak opštoj balansiranoj anesteziji u neurohirurgiji

  • Dragana B. Lončar-Stojiljković Institut za kardiovaskularne bolesti "Dedinje", Beograd
  • Žana M Maksimović Centar za biomedicinska istraživanja, Medicinski fakultet Univerziteta u Banjoj Luci
  • Marko Đurić Klinika za anesteziologiju i reanimatologiju, Kliničko-bolnički centar "Dr Dragiša Mišović - Dedinje", beograd, Srbija
DOI: https://doi.org/10.5937/scriptamed52-35617
Ključne reči: Antagonisti beta-adrenergičkih receptora, Esmolol, Opšta anestezija, Hipertenzija, Tahikardija

Sažetak


Background / Aim: In surgery, and especially in the neurosurgical operations, maintenance of cardiovascular stability during and in the phase of the immediate postoperative recovery is of vital importance. The aim of this study was to investigate the effects of continuous esmolol infusion on the values of cardiovascular parameters and quality of the emergence from anaesthesia in neurosurgical patients.

Methods: A total of 40 patients of both sexes scheduled for elective supratentorial surgery were randomly assigned to two groups. Esmolol group received intravenous (iv) infusion of esmolol esmolol dissolved in 5 % glucose solution (during the first 5 min at a rate of 0.3 mg/kg/min and thereafter at a rate of 0.1 mg/kg/min), while the ones from the control group received a 5 % glucose solution without esmolol at the same volume and rate. Cardiovascular parameters were registered at critical phases of anaesthesia and operation (induction, intubation, placement of Mayfield frame, craniotomy, skull closure, extubation). Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation.

Results: Values of systolic blood pressure and heart rate were significantly lower in the esmolol than in the control group of patients. Although the duration of anaesthesia did not differ, patients from the esmolol group required significantly less opioids and isoflurane and recovered after the anaesthesia significantly faster than the patients in the control group.

Conclusion: Ultrashort-acting beta-adrenergic receptor antagonist esmolol, administered as a continuous iv infusion, assures better cardiovascular stability and smoother emergence from the balanced inhalation general anaesthesia than the control glucose infusion in elective neurosurgical patients.

Reference

1. Wolf AR. Effects of regional analgesia on stress responses to pediatric surgery. Paediatr Anaesth 2012 Jan;22(1):19-24.



  1. Egan TD. Are opioids indispensable for general anaesthesia? Br J Anaesth 2019 Jun; 122(6):e127-e135. doi: 10.1016/j.bja.2019.02.018.

  2. Gorczynski RJ, Murthy VS, Hwang TF. Beta-blocking and hemodynamic effects of ASL-8052. J Cardiovasc Pharmacol 1984 Nov-Dec;6(6):1048-59.

  3. Girard D, Shulman BJ, Thys DM, Mindich BP, Mikula SK, Kaplan JA. The safety and efficacy of esmolol during myocardial revascularization. Anesthesiology 1986 Aug;65(2):157-64.


5. Harrison L, Ralley FE, Wynands E, Robbins GR, Sami M, Ripley R, et al. The role of an ultra short-acting adrenergic blocker (esmolol) in patients undergoing coronary artery bypass surgery. Anesthesiology 1987 Mar;66(3):413-8.



  1. Lončar-Stojiljković D. Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients. Scr Med 2021 Jun;52(2):109-14.

  2. Lončar-Stojiljković D. Effects of the ultra-short-acting beta-blocker esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery. Scr Med 2021 Sep;52(3):187-92.


8. Sharma A, Ramaswamy S, Bhatia SC. Electroconvulsive therapy after repair of cerebral aneurysm. J ECT 2005 Sep;21(3):180-1.


9. Samaha T, Ravussin P, Claquin C, Ecoffey C. [Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine]. Ann Fr Anesth Reanim 1996;15(1):36-40.


10. Alkaya MA, Saracoglu KT, Pehlivan G, Eti Z, Gogus FY. Effects of Esmolol on the Prevention of Haemodynamic Responses to Tracheal Extubation after Craniotomy Operations. Turk J Anaesthesiol Reanimatol 2014 Apr;42(2):86-90.



  1. Bhagat H, Dash HH, Bithal PK, Chouhan RS, Pandia MP. Planning for early emergence in neurosurgical patients: a randomized prospective trial of low-dose anesthetics. Anesth Analg 2008 Oct;107(4):1348-55.


12. Wiest D. Esmolol. A review of its therapeutic efficacy and pharmacokinetic characteristics. Clin Pharmacokinet. 1995 Mar;28(3):190-202. 


13. Cuneo BF, Zales VR, Blahunka PC, Benson DW Jr. Pharmacodynamics and pharmacokinetics of esmolol, a short-acting beta-blocking agent, in children. Pediatr Cardiol 1994 Nov-Dec;15(6):296-301.



  1. Gibson BE, Black S, Maass L, Cucchiara RF. Esmolol for the control of hypertension after neurologic surgery. Clin Pharmacol Ther 1988;44(6):650-3.


15. Grillo P, Bruder N, Auquier P, Pellissier D, Gouin F. Esmolol blunts the cerebral blood flow velocity increase during emergence from anesthesia in neurosurgical patients. Anesth Analg 2003 Apr;96(4):1145-9.



  1. Bilotta F, Lam AM, Doronzio A, Cuzzone V, Delfini R, Rosa G. Esmolol blunts postoperatie hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanestehsia for intracranial urgery. J Clin Anesth 2008 Sep;20(6):426-30.


17. Hosseinzadeh H, Eydi M, Ghaffarlou M, Ghabili K, Golzari SEJ. Esmolol: a unique beta-blocker in maintaining cardiovascular stability following neurosurgical procedures. Adv Pharm Bull 2012;2(2):249-52.



  1. Bruder N, Ravussin P. Recovery from anesthesia and postoperative extubation of neurosurgical patients: a review. J Neurosurg Anesthesiol 1999 Oct;11(4):282-93.

  2. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 2000 Jul;93(1):48-54.

  3. Bruder NJ. Awakening management after neurosurgery for intracranial tumours. Curr Opin Anesthesiol 2002;15:477-82.


21. Lee MH, Chung MH, Han CS, Lee JH, Choi YR, Choi EM, et al. Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy. Korean J Anesthesiol 2014 March;66(3):222-9.



  1. de Morais VBD, Sakata RK, Huang APS, da Cunha Ferraro LH. Randomized, double-blind, placebo-controlled study of the analgesic effect of intraoperative esmolol for laparoscopic gastroplasty. Acta Cir Bras 2020;35(4): e202000408. doi: 10.1590/s0102-865020200040000008.

  2. Mendonca FT, Tramontini AJ, Miake HI, Seixas LF, de Carvalho LSF, Sposito AC. Intra-operative esmolol and pain following mastectomy: A randomised clinical trial. Eur J Anaesthesiol 2021 Jul 1;38(7):735-43.

  3. Asouhidou I, Trikoupi A. Esmolol reduces anesthetic requirements thereby facilitating early extubation; a prospective controlled study in patients undergoing intracranial surgery. BMC Anesthesiology 2015 Nov 28;15:172. doi: 10.1186/s12871-015-0154-1.


25. Gruenbaum SE, Meng L, Bilotta F. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection. Curr Opin Anaesthesiol 2016 Oct;29(5):552-7.


26. Ornstein E, Young WL, Ostapkovich N, Matteo RS, Diaz J. Are all effects of esmolol equally rapid in onset? Anesth Analg 1995 Aug;81(2):297-300.


27. Srivastava VK, Agrawal S, Gautam SKS, Ahmed M, Sharma S, Kumar R. Comparative evaluation of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in neurosurgical patients. J Anaesthesiol Clin Pharmacol 2015 Apr-Jun;31(2):186-90.


28. Bebawy JF, Houston CC, Kosky JL, Badri AM, Hemmer LB, Moreland NC, et al. Nicardipine is superior to esmolol for the management of postcraniotomy emergence hypertension: a randomized open-label study. Anesth Analg 2015 Jan;120(1):186-92.



  1. Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S, et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eurasian J Med 2012 Aug;44(2):99-105.


30. Dogan SD, Ustun FE, Sener EB, Koksal E, Ustun YB, Kaya C, et al. Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations. Braz J Anesthesiol 2016;66(2):145-150.

Objavljeno
2021/12/31
Broj časopisa
Vol. 52 Br. 4 (2021): Q4/December
Rubrika
Originalni naučni članak
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