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Thomas M, Hayes K, White P, Baumer T, Beattie C, Ramesh A, Culliford L, Ackland GL, Pickering AE. Early Intravenous Beta-Blockade with Esmolol in Adults with Severe Traumatic Brain Injury: A Phase 2a Intervention Design Study. Neurocrit Care 2024:10.1007/s12028-024-02029-8. [PMID: 38951446 DOI: 10.1007/s12028-024-02029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Targeted beta-blockade after severe traumatic brain injury may reduce secondary brain injury by attenuating the sympathoadrenal response. The potential role and optimal dosage for esmolol, a selective, short-acting, titratable beta-1 beta-blocker, as a safe, putative early therapy after major traumatic brain injury has not been assessed. METHODS We conducted a single-center, open-label dose-finding study using an adaptive model-based design. Adults (18 years or older) with severe traumatic brain injury and intracranial pressure monitoring received esmolol within 24 h of injury to reduce their heart rate by 15% from baseline of the preceding 4 h while ensuring cerebral perfusion pressure was maintained above 60 mm Hg. In cohorts of three, the starting dosage and dosage increments were escalated according to a prespecified plan in the absence of dose-limiting toxicity. Dose-limiting toxicity was defined as failure to maintain cerebral perfusion pressure, triggering cessation of esmolol infusion. The primary outcome was the maximum tolerated dosage schedule of esmolol, defined as that associated with less than 10% probability of dose-limiting toxicity. Secondary outcomes include 6-month mortality and 6-month extended Glasgow Outcome Scale score. RESULTS Sixteen patients (6 [37.5%] female patients; mean age 36 years [standard deviation 13 years]) with a median Glasgow Coma Scale score of 6.5 (interquartile range 5-7) received esmolol. The optimal starting dosage of esmolol was 10 μg/kg/min, with increments every 30 min of 5 μg/kg/min, as it was the highest dosage with less than 10% estimated probability of dose-limiting toxicity (7%). All-cause mortality was 12.5% at 6 months (corresponding to a standardized mortality ratio of 0.63). One dose-limiting toxicity event and no serious adverse hemodynamic effects were seen. CONCLUSIONS Esmolol administration, titrated to a heart rate reduction of 15%, is feasible within 24 h of severe traumatic brain injury. The probability of dose-limiting toxicity requiring withdrawal of esmolol when using the optimized schedule is low. Trial registrationI SRCTN, ISRCTN11038397, registered retrospectively January 7, 2021 ( https://www.isrctn.com/ISRCTN11038397 ).
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Affiliation(s)
- Matt Thomas
- Intensive Care Unit, North Bristol NHS Trust, Bristol, UK.
| | - Kati Hayes
- Research and Development, North Bristol NHS Trust, Bristol, UK
| | - Paul White
- School of Data Science and Mathematics, University of the West of England, Bristol, UK
| | | | - Clodagh Beattie
- Research and Development, North Bristol NHS Trust, Bristol, UK
| | - Aravind Ramesh
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Bristol Medical School (PHS), Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Gareth L Ackland
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Thomas M, Hayes K, White P, Ramesh A, Culliford L, Ackland G, Pickering A. Early Intravenous Beta-Blockade with Esmolol in Adults with Severe Traumatic Brain Injury (EBB-TBI): Protocol for a Phase 2a Intervention Design Study. Neurocrit Care 2024; 40:795-806. [PMID: 37308729 PMCID: PMC10959800 DOI: 10.1007/s12028-023-01755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
Traumatic brain injury is a leading cause of death and disability worldwide. Interventions that mitigate secondary brain injury have the potential to improve outcomes for patients and reduce the impact on communities and society. Increased circulating catecholamines are associated with worse outcomes and there are supportive animal data and indications in human studies of benefit from beta-blockade after severe traumatic brain injury. Here, we present the protocol for a dose-finding study using esmolol in adults commenced within 24 h of severe traumatic brain injury. Esmolol has practical advantages and theoretical benefits as a neuroprotective agent in this setting, but these must be balanced against the known risk of secondary injury from hypotension. The aim of this study is to determine a dose schedule for esmolol, using the continual reassessment method, that combines a clinically significant reduction in heart rate as a surrogate for catecholamine drive with maintenance of cerebral perfusion pressure. The maximum tolerated dosing schedule for esmolol can then be tested for patient benefit in subsequent randomized controlled trials.Trial registration ISRCTN, ISRCTN11038397, registered retrospectively 07/01/2021 https://www.isrctn.com/ISRCTN11038397.
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Affiliation(s)
- Matt Thomas
- Intensive Care Unit, North Bristol NHS Trust, Bristol, UK.
| | - Kati Hayes
- Intensive Care Unit, North Bristol NHS Trust, Bristol, UK
| | - Paul White
- School of Data Science and Mathematics, University of the West of England, Bristol, UK
| | - Aravind Ramesh
- GW4 Clinical Academic Training Programme for Health Professionals, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Bristol Trials Centre, Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Gareth Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony Pickering
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Wang J, Gao X, He Z, Wang J, Xu G, Li T. Evaluating the effects of Esmolol on cardiac function in patients with Septic cardiomyopathy by Speck-tracking echocardiography-a randomized controlled trial. BMC Anesthesiol 2023; 23:51. [PMID: 36765286 PMCID: PMC9912519 DOI: 10.1186/s12871-023-01983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Esmolol as one treatment of sepsis induced cardiomyopathy (SIC) is still controversial. The objective of this study is to evaluate cardiac function after reducing heart rate by Esmolol in patients with SIC using speck-tracking echocardiography. METHODS This study was a single-center, prospective, and randomized controlled study. A total of 100 SIC patients with a heart rate more than 100/min, admitted to the Intensive Care Department of Tianjin Third Central Hospital from March 1, 2020 to September 30, 2021, were selected as the research subjects. They were randomly divided into the Esmolol group (Group E) and the conventional treatment group (Group C), each with 50 cases. The target heart rate of patients in Group E was controlled between 80/min and 100/min. Speck-tracking echocardiography (STE) and pulse indicating continuous cardiac output monitoring (PICCO) were performed in both groups at 1 h, 24 h, 48 h, 72 h, 96 h and 7 d after admission, with data concerning left ventricular global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and global ejection fraction (GEF), left ventricular systolic force index (dP/dtmx) were obtained, respectively. Hemodynamics and other safety indicators were monitored throughout the whole process. These subjects were followed up to 90 d, with their mortality recorded at Day 28 and Day 90, respectively. Statistical analyses were performed using SPSS version 21. RESULTS With 24 h of Esmolol, all patients in Group E achieved the target heart rate, and there was no deterioration of GLS, or adverse events. However, compared with those in Group C, their GLS, GEF and dP/dtmx were increased, and the difference was statistically significant (P > 0.05). Compared with patients in Group C, those in Group E had lower short-term mortality, and logistic regression analysis also suggested that Esmolol improved patient outcomes. CONCLUSION In SIC patients, the application of Esmolol to lower heart rate decreased their short-term mortality while not making any impairment on the myocardial contractility. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2100047513. Registered June 20, 2021- Retrospectively registered, http://www.chictr.org.cn/index.aspx . The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines.
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Affiliation(s)
- Junyi Wang
- grid.265021.20000 0000 9792 1228The Third Central Clinical College of Tianjin Medical University, Tianjin, 300170 China ,The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170 China ,grid.417032.30000 0004 1798 6216Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin, China ,grid.417032.30000 0004 1798 6216Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Xinjing Gao
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170 China ,grid.417032.30000 0004 1798 6216Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin, China ,grid.417032.30000 0004 1798 6216Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Zhengzhong He
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170 China ,grid.417032.30000 0004 1798 6216Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin, China ,grid.417032.30000 0004 1798 6216Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Jinxiang Wang
- grid.33763.320000 0004 1761 2484Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou 325026 Zhejiang, People’s Republic of China ,grid.412645.00000 0004 1757 9434Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300052 People’s Republic of China
| | - Guowu Xu
- grid.33763.320000 0004 1761 2484Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou 325026 Zhejiang, People’s Republic of China ,grid.412645.00000 0004 1757 9434Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300052 People’s Republic of China
| | - Tong Li
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China. .,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin, China. .,Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
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Rafie N, Matchett CL, Jentzer JC. 38-Year-Old Woman With Chest Pain. Mayo Clin Proc 2023; 98:187-192. [PMID: 36603947 DOI: 10.1016/j.mayocp.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Nikita Rafie
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Caroline L Matchett
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jacob C Jentzer
- Advisor to residents and Consultant in Cardiovascular Medicine and Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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BARTAKOVA A, NOVAKOVA M, STRACINA T. Anesthetized guinea pig as a model for drug testing. Physiol Res 2022; 71:S211-S218. [PMID: 36647909 PMCID: PMC9906665 DOI: 10.33549/physiolres.934994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Based on the World Health Organization statistics, cardiovascular diseases represent the major cause of death worldwide. Although a wide range of treatment approaches and pharmaceuticals is available, the therapy is often not effective enough and therefore health risks for the patient persist. Thus, it is still essential to test new drug candidates for the treatment of various pathophysiological conditions related to cardiovascular system. In vivo models represent indispensable part of preclinical testing of such substances. Anesthetized guinea pig as a whole-body model allows to evaluate complex reactions of cardiovascular system to tested substance. Moreover, action potential of guinea pig cardiomyocyte is quite comparable to that of human. Hence, the results from this model are then quite well translatable to clinical medicine. Aim of this paper was to summarize the methodology of this model, including its advantages and/or limitations and risks, based on the effects of two substances with adrenergic activity on the ECG parameters. The model of anesthetized guinea pig proved to be valuable and suitable for testing of drugs with cardiovascular effects.
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Affiliation(s)
- Anna BARTAKOVA
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marie NOVAKOVA
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tibor STRACINA
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Imai T, Isozaki M, Ohura K. Esterases Involved in the Rapid Bioconversion of Esmolol after Intravenous Injection in Humans. Biol Pharm Bull 2022; 45:1544-1552. [PMID: 36184514 DOI: 10.1248/bpb.b22-00468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Esmolol is indicated for the acute and temporary control of ventricular rate due to its rapid onset of action and elimination at a rate greater than cardiac output. This rapid elimination is achieved by the hydrolysis of esmolol to esmolol acid. It has previously been reported that esmolol is hydrolyzed in the cytosol of red blood cells (RBCs). In order to elucidate the metabolic tissues and enzymes involved in the rapid elimination of esmolol, a hydrolysis study was performed using different fractions of human blood and liver. Esmolol was slightly hydrolyzed by washed RBCs and plasma proteins while it was extensively hydrolyzed in plasma containing white blood cells and platelets. The negligible hydrolysis of esmolol in RBCs is supported by its poor hydrolysis by esterase D, the sole cytosolic esterase in RBCs. In human liver microsomes, esmolol was rapidly hydrolyzed according to Michaelis-Menten kinetics, and its hepatic clearance, calculated by the well-stirred model, was limited by hepatic blood flow. An inhibition study and a hydrolysis study using individual recombinant esterases showed that human carboxylesterase 1 isozyme (hCE1) is the main metabolic enzyme of esmolol in both white blood cells and human liver. These studies also showed that acyl protein thioesterase 1 (APT1) is involved in the cytosolic hydrolysis of esmolol in the liver. The hydrolysis of esmolol by hCE1 and APT1 also results in its pulmonary metabolism, which might be a reason for its high total clearance (170-285 mL/min/kg bodyweight), 3.5-fold greater than cardiac output (80.0 mL/min/kg bodyweight).
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Affiliation(s)
- Teruko Imai
- Graduate School of Pharmaceutical Sciences, Kumamoto University.,Daiichi University of Pharmacy
| | - Mizuki Isozaki
- Graduate School of Pharmaceutical Sciences, Kumamoto University
| | - Kayoko Ohura
- Graduate School of Pharmaceutical Sciences, Kumamoto University.,Headquarters for Admissions and Education, Kumamoto University
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7
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Hwang JC, Kim M, Kim S, Seo H, An S, Jang EH, Han SY, Kim MJ, Kim NK, Cho SW, Lee S, Park JU. In situ diagnosis and simultaneous treatment of cardiac diseases using a single-device platform. SCIENCE ADVANCES 2022; 8:eabq0897. [PMID: 36103536 PMCID: PMC9473581 DOI: 10.1126/sciadv.abq0897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 06/07/2023]
Abstract
The in situ diagnosis of cardiac activities with simultaneous therapeutic electrical stimulation of the heart is key to preventing cardiac arrhythmia. Here, we present an unconventional single-device platform that enables in situ monitoring even in a wet condition and control of beating heart motions without interferences to the recording signal. This platform consists of the active-matrix array of pressure-sensitive transistors for detecting cardiac beatings, biocompatible, low-impedance electrodes for cardiac stimulations, and an alginate-based hydrogel adhesive for attaching this platform conformally to the epicardium. In contrast to conventional electrophysiological sensing using electrodes, the pressure-sensitive transistors measured mechanophysiological characteristics by monitoring the spatiotemporal distributions of cardiac pressures during heart beating motions. In vivo tests show mechanophysiological readings having good correlation with electrocardiography and negligible interference with the electrical artifacts caused during cardiac stimulations. This platform can therapeutically synchronize the rhythm of abnormal heartbeats through efficient pacing of cardiac arrhythmia.
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Affiliation(s)
- Jae Chul Hwang
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Moohyun Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Sumin Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Hunkyu Seo
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Soohwan An
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung Yeop Han
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Mi Jung Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Nam Kyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung-Woo Cho
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Jang-Ung Park
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
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Kramer AM, Kiss A, Heber S, Chambers DJ, Hallström S, Pilz PM, Podesser BK, Santer D. Normothermic blood polarizing versus depolarizing cardioplegia in a porcine model of cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2022; 35:ivac152. [PMID: 35640544 PMCID: PMC9199933 DOI: 10.1093/icvts/ivac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/30/2022] [Accepted: 05/25/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We have previously demonstrated beneficial cardiac protection with hypothermic polarizing cardioplegia compared to a hyperkalemic depolarizing cardioplegia. In this study, a porcine model of cardiopulmonary bypass was used to compare the protective effects of normothermic blood-based polarizing and depolarizing cardioplegia during cardiac arrest. METHODS Thirteen pigs were randomized to receive either normothermic polarizing (n = 8) or depolarizing (n = 5) blood-based cardioplegia. After initiation of cardiopulmonary bypass, normothermic arrest (34°C, 60 min) was followed by 60 min of on-pump and 90 min of off-pump reperfusion. Primary outcome was myocardial injury measured as arterial myocardial creatine kinase concentration. Secondary outcome was haemodynamic function and the energy state of the hearts. RESULTS During reperfusion, release of myocardial creatine kinase was comparable between groups (P = 0.36). In addition, most haemodynamic parameters showed comparable results between groups, but stroke volume (P = 0.03) was significantly lower in the polarizing group. Adenosine triphosphate levels were significantly (18.41 ± 3.86 vs 22.97 ± 2.73 nmol/mg; P = 0.03) lower in polarizing hearts, and the requirement for noradrenaline administration (P = 0.002) and temporary pacing (6 vs 0; P = 0.02) during reperfusion were significantly higher in polarizing hearts. CONCLUSIONS Under normothermic conditions, polarizing blood cardioplegia was associated with similar myocardial injury to depolarizing blood cardioplegia. Reduced haemodynamic and metabolic outcome and a higher need for temporary pacing with polarized arrest may be associated with the blood-based dilution of this solution.
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Affiliation(s)
- Anne-Margarethe Kramer
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David J Chambers
- Cardiac Surgical Research, The Rayne Institute (King’s College London), Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Seth Hallström
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Patrick M Pilz
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - David Santer
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
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Lončar-Stojiljković D, Maksimović Ž, Đurić M. Use of an ultrashort-acting selective β1-adrenergic receptor antagonist esmolol in ear, nose and throat surgery. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-37135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background / Aim: The concept of general balanced anaesthesia was devised in order to assure cardiovascular stability and fast post-anaesthesia recovery. This clinical trial was organised in order to investigate the parameters of cardiovascular function and emergence from anaesthesia in elective ear, nose and throat (ENT) surgery patients. Methods: A total of 40 ASA I and II patients of both sexes scheduled for elective ENT surgery were randomly divided into two equal groups. Both groups received a continuous IV infusion of glucose 5 % solution and in the esmolol group this infusion also contained esmolol. Esmolol infusion rate was 0.3 mg/kg/min during the first 5 min and thereafter 0.1 mg/kg/min. In critical phases of anaesthesia and operation (induction, intubation, first incision, surgical manipulations, wound suture, extubation), systolic and diastolic blood pressure were monitored. Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation. Increases in cardiovascular parameters by 20 % of the baseline values or more were treated with IV boluses of fentanyl, alone or with droperidol and, if necessary, by adding isoflurane 0.5 % to the inhalational mixture. Consumption of drugs was recorded. Results: Esmolol assured stable values of cardiovascular parameters that were in most critical phases of anaesthesia and operation lower than in the control group. The duration of anaesthesia did not differ between the groups. In the esmolol group, lower consumption of fentanyl, droperidol and sevoflurane was registered. Patients in the esmolol group emerged from anaesthesia faster than patients in the control group. Conclusion: Continuous IV infusion of esmolol assures better cardiovascular stability, necessitates lower consumption of analgesics and anaesthetics and results in faster emergence from general anaesthesia in elective ENT surgery.
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Lončar-Stojiljković D, Maksimović Ž, Đurić M. Esmolol as an adjunct to general balanced anaesthesia in neurosurgery. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-35617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
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 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 durations 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.
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Lončar-Stojiljković D. Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-32892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Esmolol is a cardioselective b-adrenergic antagonist that is used during general anaesthesia to blunt the sympathetic reflex tachycardia and hypertension. The aim of the study was to investigate whether the potential beneficial and adverse effects of esmolol differ depending on the patient age. Methods: A total of 50 ASA I/II patients scheduled for elective upper abdominal surgery were divided in two groups: younger (patients aged up to 35 years) and older (patients older than 65). After premedication with Diazepam, they were infused with esmolol during the first 5 min at a rate of 0.3 mg/kg/min and 0.1 mg/kg/min thereafter. Anaesthesia was induced with thiopental sodium 3-5 mg/kg intravenously (iv) and fentanyl 1.5 µg/kg IV. Tracheal intubation was facilitated with suxamethonium 1-2 mg/kg IV. Long-term neuromuscular blockade was induced with pancuronium bromide 0.07 mg/kg IV bolus and maintained with incremental IV boluses of 0.01 mg/ kg. Inhalational anaesthesia was maintained with a mixture of oxygen and nitrous oxide (O2 /N2 O) 2 : 1. Results: The systolic blood pressure remained constant during the intubation phase in the group of older patients, at the same time being around 89 % of the pre-induction values, while in younger patients it rose up to 100 %. During the same phase of anaesthesia, the diastolic blood pressure in older patients remained at about 91 %, while in younger patients it rose up to 107 % of the pre-induction values. The consumption of drugs and the speed and quality of the recovery from anaesthesia did not differ between the two groups of patients. Conclusion: Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery equally in younger and older patients.
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12
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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. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-34205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: Esmolol is an ultra-short-acting, easily titratable b-adrenergic receptor antagonist used for urgent treatment of hypertension and tachycardia in non-surgical and surgical settings. Aim of this clinical study was to investigate its cardiovascular effects and quality of the emergence from anaesthesia in patients scheduled for elective plastic surgery under general balanced anaesthesia. Methods: A total of 30 ASA I/II patients were randomised in two groups of similar demographic characteristics and baseline values of cardiovascular parameters. Esmolol group received esmolol dissolved in glucose 5 % as an intravenous infusion, 0.3 mg/kg/min during the first 5 min and at a rate of 0.1 mg/kg/ min thereafter. Control patients received the solvent only, at the same rate and volume. General balanced anaesthesia was induced with thiopentone sodium and fentanyl and maintained with nitrous oxide and oxygen. Neuromuscular relaxation was assured with pancuronium bromide and was antagonised at the end of operation with atropine and neostigmine. Systolic and diastolic blood pressure and heart rate were registered at all critical phases: (1) immediately prior to the induction (baseline value), (2) induction to anaesthesia, (3) tracheal intubation, (4) first skin incision, (5) surgical manipulation with organs, (6) suture of the surgical wound and (7) tracheal extubation. Drug consumption and quality of postoperative recovery were monitored. Results: In most of the critical phases of anaesthesia and operation, patients from the Esmolol group had significantly lower values of cardiovascular parameters than the patients from the Control group. Esmolol-treated patients needed less fentanyl, droperidol and pancuronium and had faster and smoother emergence from anaesthesia than the control patients. Conclusion: Esmolol improved haemodynamics and post-anaesthesia recovery in patients undergoing elective plastic surgery under general balanced anaesthesia.
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Krumpl G, Ulč I, Trebs M, Hodisch J, Kadlecová P, Husch B. Dobutamine Alters the Pharmacokinetic and Pharmacodynamic Behavior of Esmolol. Cureus 2020; 12:e12217. [PMID: 33500851 PMCID: PMC7819280 DOI: 10.7759/cureus.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and objective This study involved an investigation into the pharmacokinetic and pharmacodynamic behavior of esmolol in the presence of dobutamine in healthy subjects of European ancestry. Methods We conducted a single-center, prospective randomized study of 16 healthy subjects with each receiving an infusion of dobutamine sufficient to increase heart rate (HR) by 30 beats per minute (bpm) followed by a 60-minute infusion of 50 µg/kg/min esmolol. Pharmacokinetics, HR, and blood pressure were evaluated for 180 minutes. Results In the presence of dobutamine, esmolol elimination was substantially faster than without dobutamine, Esmolol infusion reduced dobutamine-induced elevation of HR reversibly whereas the dobutamine-induced systolic blood pressure (SBP) reduction did not recover after the termination of the esmolol infusion. No serious adverse events (AEs) were observed. Conclusions The accelerated elimination of esmolol was likely due to higher cleavage through tissue esterases induced by dobutamine-induced increased tissue passage cycles per time unit. The HR effect was characteristic of a beta-blocker, whereas the blood pressure effect was likely due to a mechanism other than direct beta-blockade. HR remained elevated after the infusion of esmolol and dobutamine, most likely due to persistent blood pressure reduction.
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Affiliation(s)
| | - Ivan Ulč
- Pharmacology, Center for Pharmacology and Analysis (CEPHA) s.r.o, Plzeň, CZE
| | - Michaela Trebs
- Operational Business Development, AOP Orphan Pharmaceuticals AG, Vienna, AUT
| | - Juri Hodisch
- Drug Safety, AOP Orphan Pharmaceuticals AG, VIenna, AUT
| | - Pavla Kadlecová
- Biostatistics, Advanced Drug Development Services (ADDS) s.r.o, Brno, CZE
| | - Bernhard Husch
- Research and Development, AOP Orphan Pharmaceuticals AG, Vienna, AUT
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Kang JK, Yoo SH, Chung JH, Kim NS, Jung HS, Seo YH, Chun HR, Gong HY, Son HD, Kim AJ. Dosing study of esmolol for reducing hemodynamic changes during lightwand intubation. Anesth Pain Med (Seoul) 2020; 15:417-423. [PMID: 33329844 PMCID: PMC7724119 DOI: 10.17085/apm.19067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation. Methods The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation. Results The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group. Conclusions Esmolol injection, 1-2 mg/kg, prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.
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Affiliation(s)
- Jin Ku Kang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sie Hyeon Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jin Hun Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyung Yoon Gong
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hee Dong Son
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - A Joo Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Bajracharya JL, Subedi A, Pokharel K, Bhattarai B. The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial. BMC Anesthesiol 2019; 19:198. [PMID: 31684867 PMCID: PMC6829809 DOI: 10.1186/s12871-019-0874-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023] Open
Abstract
Background As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. Methods In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively. Results Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later. Conclusion Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol. Trial registration ClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.
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Affiliation(s)
| | - Asish Subedi
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, BPKIHS, Dharan, Nepal.
| | - Krishna Pokharel
- Department of Anesthesiology & Critical Care Medicine, BPKIHS, Dharan, Nepal
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Abdelgalel EF. Controlled hypotensive anesthesia for endoscopic endonasal repair of cerebrospinal fluid rhinorrhea: A comparison between clevidipine and esmolol: Randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Essam F. Abdelgalel
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Amin SM, Elmawy MGE. Optimizing surgical field during cochlear implant surgery in children: Dexmedetomidine versus Esmolol. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sabry Mohamed Amin
- Departments of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
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Lavere PF, Rana NA, Kinsky MP, Funston JS, Mohamed SS, Chaaban MR. Blood Loss and Visibility with Esmolol vs Labetalol in Endoscopic Sinus Surgery: A Randomized Clinical Trial. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619847992. [PMID: 31205435 PMCID: PMC6537490 DOI: 10.1177/1179550619847992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
Objectives: Improved intraoperative visibility during functional endoscopic sinus surgery (FESS) decreases the risk of serious orbital or skull base injuries. Esmolol and labetalol have been used to reduce bleeding and achieve better visibility, but it remains unclear which drug is more effective. This study aims to measure visibility scores and mucosal bleeding rates for esmolol and labetalol in FESS. Methods: This is a 1-year randomized double-blind trial of adults undergoing FESS at a tertiary academic center. The inclusion criteria were as follows: age 18 or older; history of chronic rhinosinusitis (CRS) with or without nasal polyps; undergoing FESS for CRS; and American Society of Anesthesiologists (ASA) physical status 1 (healthy) or 2 (patient with mild systemic disease). The exclusion criteria were as follows: pregnancy; asthma, chronic obstructive pulmonary disease (COPD), bradycardia, heart failure, end-stage renal disease, cerebrovascular accident, diabetes mellitus; preoperative use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or beta-blockers; and body mass index (BMI) greater than 40 kg/m2. Patients received either dose-infused esmolol or intravenous push labetalol. The primary outcome was intraoperative visibility determined by surgeon using validated scoring systems (Boezaart, Wormald). The secondary outcome was hemodynamic control (rate of blood loss, average mean arterial pressure [MAP], average heart rate [HR]). Hypothesis of no difference between drugs formed before data collection. Results: Of the 32 adults given drug (mean age = 50), 28 patients (13 esmolol and 15 labetalol) with complete data were included in the final analysis. There were no statistically significant differences between esmolol and labetalol in rate of blood loss (0.59 [0.28] vs 0.66 [0.37] mL/min, P = 0.62), average MAP (79.7 [7.5] vs 79.4 [7.7] mm Hg, P = .93), HR (72 [8.7] vs 68 [11.7] bpm, P = .26), or mean visibility scores for the Boezaart (3.1 [0.69] vs 3.1 [0.89], P = .85) and Wormald (6.1 [1.7] vs 5.9 [1.9], P = .72) grading scales. Conclusions: There were no significant differences between esmolol and labetalol in rate of blood loss, MAP control, HR, or surgical visibility in FESS. Either drug may be used, and other considerations (availability, cost) can dictate choice.
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Affiliation(s)
- Philip F Lavere
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Nikunj A Rana
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael P Kinsky
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - J Sean Funston
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sharif S Mohamed
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamad R Chaaban
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, TX, USA
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Ye F, Jiang W, Wang Y, Lin W, Chen H, Pan B. Aggravation of atrial arrhythmia by amiodarone during the perinatal period: A case report. Medicine (Baltimore) 2019; 98:e14466. [PMID: 30762762 PMCID: PMC6408133 DOI: 10.1097/md.0000000000014466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Amiodarone, a broad-spectrum antiarrhythmic drug, is widely used for the clinical treatment of tachyarrhythmias because of its safety and efficacy. PATIENT CONCERNS A 30-year-old woman presented with known paroxysmal atrial tachycardia and severe preeclampsia. Two days before admission, she had given birth to twins. She described her symptoms as a sudden palpitation at 10:20 accompanied by chest tightness and shortness of breath. DIAGNOSIS Cardiac arrhythmia and acute left heart failure. INTERVENTIONS Furosemide and sodium nitroprusside were administered to control the heart failure. At 16:20, 150 mg amiodarone (15 mg/min) was injected intravenously and continued at 1 mg/min. At 16:50, her electrocardiogram showed possible atrial tachycardia or atrial flutter with a ventricular rate of 206 beats/min. Administration of amiodarone was stopped at 17:23, and the medication was changed to esmolol. OUTCOMES After 3 minutes, the palpitations stopped, the heart rate changed to a sinus rhythm, and the ventricular rate was 100 beats/min. Four days later, the patient underwent an electrophysiologic study and radiofrequency ablation. LESSONS When amiodarone is used to treat atrial arrhythmia, the ventricular rate may accelerate, which can cause patients with borderline heart failure to develop acute heart failure or further deterioration of acute heart failure. For heart failure induced or mediated by atrial arrhythmias, short-term β-blockers may be used to control the ventricular rate more quickly and effectively and to prevent the progression of heart failure.
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Xu W, Wang S, Wang W, Zhang P, Tang K. Experiments and simulation on extraction of esmolol enantiomers from single stage to multistage. Sep Purif Technol 2018. [DOI: 10.1016/j.seppur.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lafarge L, Bourguignon L, Bernard N, Vial T, Dehan-Moya MJ, De La Gastine B, Goutelle S. [Pharmacokinetic risk factors of beta-blockers overdose in the elderly: Case report and pharmacology approach]. Ann Cardiol Angeiol (Paris) 2018; 67:91-97. [PMID: 29544975 DOI: 10.1016/j.ancard.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/18/2018] [Indexed: 12/15/2022]
Abstract
Beta-blockers are widely prescribed in elderly patients and may induce severe adverse drug reactions. We report a case of bisoprolol-induced bradycardia in an elderly patient with impaired renal function and use of cytochrome P450 inhibitors. A literature review has been performed in order to analyze pharmacokinetic risk factors of beta-blockers overdosing in geriatrics. Various mechanisms can result in decreased elimination of beta-blockers. These mechanisms vary according to the beta-blocker agent and may be combined in some individuals, especially elderly patients. This can lead to unexpected overexposure. Knowledge about drug interactions and pharmacokinetic elimination pathways is important for preventing overexposure and adverse drug reactions when using beta-blockers.
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Affiliation(s)
- L Lafarge
- Service pharmaceutique, centre hospitalier Pierre-Garraud, groupement hospitalier Nord, hospices civils de Lyon, 136, rue Commandant-Charcot, 69005 Lyon, France.
| | - L Bourguignon
- Service pharmaceutique, centre hospitalier Pierre-Garraud, groupement hospitalier Nord, hospices civils de Lyon, 136, rue Commandant-Charcot, 69005 Lyon, France; ISPB, faculté de pharmacie de Lyon, université de Lyon-1, 69008 Lyon, France; UMR CNRS 5558, laboratoire de biométrie et biologie évolutive, université Lyon-1, 69100 Villeurbanne, France
| | - N Bernard
- Centre régional de pharmacovigilance, hospices civils de Lyon, 162, avenue Lacassagne, 69003 Lyon, France
| | - T Vial
- Centre régional de pharmacovigilance, hospices civils de Lyon, 162, avenue Lacassagne, 69003 Lyon, France
| | - M-J Dehan-Moya
- Gériatrie, centre hospitalier Pierre-Garraud, groupement hospitalier Nord, hospices civils de Lyon, 136, rue Commandant-Charcot, 69005 Lyon, France
| | - B De La Gastine
- Gériatrie, centre hospitalier Pierre-Garraud, groupement hospitalier Nord, hospices civils de Lyon, 136, rue Commandant-Charcot, 69005 Lyon, France
| | - S Goutelle
- Service pharmaceutique, centre hospitalier Pierre-Garraud, groupement hospitalier Nord, hospices civils de Lyon, 136, rue Commandant-Charcot, 69005 Lyon, France; ISPB, faculté de pharmacie de Lyon, université de Lyon-1, 69008 Lyon, France; UMR CNRS 5558, laboratoire de biométrie et biologie évolutive, université Lyon-1, 69100 Villeurbanne, France
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Banoth L, Banerjee U. New chemical and chemo-enzymatic synthesis of (RS)-, (R)-, and (S)-esmolol. ARAB J CHEM 2017. [DOI: 10.1016/j.arabjc.2014.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Watts R, Thiruvenkatarajan V, Calvert M, Newcombe G, van Wijk RM. The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol 2017; 33:28-39. [PMID: 28413270 PMCID: PMC5374827 DOI: 10.4103/0970-9185.202182] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Esmolol has been shown to improve postoperative pain and reduce opioid requirements. The aim of this systematic review was to evaluate the effect of perioperative esmolol as an adjunct on early postoperative pain intensity, recovery profile, and anesthetic requirement. Databases were searched for randomized placebo-controlled trials evaluating the effects of esmolol during general anesthesia. Primary outcomes were related to early postoperative pain whereas secondary outcomes were related to emergence time, postoperative nausea and vomiting, and intraoperative anesthetic requirement. Nineteen trials were identified involving 936 patients (esmolol = 470, placebo = 466). In esmolol group, numeric pain scores at rest in the immediate postoperative period were reduced by 1.16 (95% confidence interval [CI]: 1.97–0.35, I2 = 96.7%) out of 10. Opioid consumption was also decreased in the postanesthesia care unit compared with placebo, mean difference of 5.1 mg (95% CI: 7.0–3.2, I2 = 96.9%) morphine IV equivalents; a 69% reduction in opioid rescue dosing was noted (odds ratio [OR]: 0.31, 95% CI: 0.16–0.80, I2 = 0.0%). A 61% reduction in postoperative nausea and vomiting was also evident (OR: 0.39, 95% CI: 0.20–0.75, I2 = 60.7%). A reduction in propofol induction dose was noted in the esmolol group (mean difference: −0.53 mg/kg, 95% CI: −0.63–−0.44, I2 = 0.0%). A decrease in end-tidal desflurane equivalent (mean difference: 1.70%, 95% CI: −2.39–−1.02, I2 = 92.0%) and intraoperative opioid usage (fentanyl equivalent, mean difference: 440 μg, 95% CI: −637–−244, I2 = 99.6%) was observed in esmolol group. Esmolol had no effect on the emergence time. Perioperative esmolol as an adjunct may reduce postoperative pain intensity, opioid consumption, and postoperative nausea vomiting. Given the heterogeneity, larger clinical trials are warranted to confirm these findings.
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Affiliation(s)
- Richard Watts
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide 5011, South Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide 5000, South Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide 5011, South Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide 5000, South Australia
| | - Marni Calvert
- Department of Anaesthesia, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia
| | - Graeme Newcombe
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide 5011, South Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide 5000, South Australia
| | - Roelof M van Wijk
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide 5011, South Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide 5000, South Australia
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Liu X, Shao F, Yang L, Jia Y. A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery. Exp Ther Med 2016; 12:2990-2996. [PMID: 27882105 PMCID: PMC5103733 DOI: 10.3892/etm.2016.3725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
The protective effects of preprocedural esmolol on myocardial injury and hemodynamics have not, to date, been investigated in patients who were scheduled for cardiac surgeries under a cardiopulmonary bypass (CPB). A pilot randomized controlled trial was performed at The First Affiliated Hospital of Dalian Medical University (Dalian, China). Patients scheduled for elective open-heart surgeries under CBP were included, and were randomized to esmolol and control groups. For patients in the esmolol groups, intravenous esmolol (70 µg/kg/min) was administered at the time of incision until CPB was performed. For patients assigned to the control group, equal volumes of 0.9% saline were administered. Markers of myocardial injury and hemodynamic parameters were observed until 12 h post surgery. A total of 24 patients were included in the present study. No significant differences in hemodynamic parameters, including the central venous pressure and heart rate, were detected between patients in the two groups during the perioperative period or within the first 12 h post-surgery (P>0.05), except for the mean arterial pressure, which was higher in the esmolol group compared with the control group at 5 and 12 h post-surgery (P<0.05). However, the serum level of cardiac troponin I was higher in patients of the control group compared with those of the esmolol group during the preoperative period (P<0.05). Although creatinine kinase was significantly different at T2 between the two groups, its MB isoenzyme was not significantly different between the groups (P>0.05). In addition, administration of esmolol was not associated with an increased risk for severe complications and adverse events in these patients. In conclusion, preoperative esmolol may be an effective and safe measure of myocardial protection for patients who undergo elective cardiac surgeries under CBP.
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Affiliation(s)
- Xue Liu
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Fengxia Shao
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Liu Yang
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Youhai Jia
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
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Louizos AA, Hadzilia SJ, Davilis DI, Samanta EG, Georgiou LG. Administration of Esmolol in Microlaryngeal Surgery for Blunting the Hemodynamic Response during Laryngoscopy and Tracheal Intubation in Cigarette Smokers. Ann Otol Rhinol Laryngol 2016; 116:107-11. [PMID: 17388233 DOI: 10.1177/000348940711600205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Cigarette smokers constitute a group of patients with an increased hemodynamic response to tracheal intubation. We studied the dose-response and side effects of bolus administration of esmolol hydrochloride in cigarette smokers undergoing elective microlaryngeal surgery, when esmolol was used for reducing the intense hemodynamic response to laryngoscopy and tracheal intubation. Methods: We randomly allocated 165 patients (American Society of Anesthesiologists physical status classes I to III) to receive placebo (Eplac) or esmolol 1 mg/kg (E1) or 2 mg/kg (E2). The esmolol was given 2 minutes before laryngoscopy and tracheal intubation. The same anesthetic technique was used in all patients. Cardiovascular parameters were recorded every minute for the first 5 minutes and thereafter every 3 minutes. Bronchospasm, other side effects, and rescue esmolol treatment were noted during anesthesia. Results: In group Eplac, significant increases (p < .05) in arterial blood pressure and heart rate were observed in the first 3 minutes after tracheal intubation. In group E1, significant increases (p < .05) in diastolic blood pressure were observed in the first 2 minutes after intubation. In group E2, no significant fluctuations were recorded in cardiovascular parameters after intubation. During surgery, 17% of the patients in group Eplac showed an increase in blood pressure and tachycardia. Conclusions: We conclude that esmolol administration of 2 mg/kg during induction of anesthesia in smokers provides hemodynamic stability after laryngoscopy and tracheal intubation with no severe side effects.
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Affiliation(s)
- Antonios A Louizos
- Department of Anesthesiology, Hippocration General Hospital, Athens, Greece
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Abstract
Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short acting. In this article, data available in publications located through a PubMed search are reviewed and specific dysrhythmias that are likely to occur during donor care are described. Treatment recommendations are based on guidelines from the American Heart Association.
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Affiliation(s)
- David J Powner
- The University of Texas Health Science Center at Houston, USA
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Duan EH, Oczkowski SJW, Belley-Cote E, Whitlock R, Lamontagne F, Devereaux PJ, Cook DJ. β-Blockers in sepsis: protocol for a systematic review and meta-analysis of randomised control trials. BMJ Open 2016; 6:e012466. [PMID: 27338886 PMCID: PMC4932247 DOI: 10.1136/bmjopen-2016-012466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sepsis is a common and deadly complication of infection. As part of the host response, sympathetic stimulation can result in septic myocardial depression, and metabolic, haematological and immunological dysfunction. Administration of β-blockers may attenuate this pathophysiological response to infection, but the effects on clinical outcomes are unknown. The objective of this systematic review is to determine the efficacy and safety of β-blockers in adults with sepsis using data from randomised control trials. METHODS AND ANALYSIS We will identify randomised control trials comparing treatment with β-blockers, versus placebo or standard care in adults with sepsis. Data sources will include MEDLINE, EMBASE, CENTRAL, clinical trial registries and conference proceedings. Two reviewers will independently determine trial eligibility. For each included trial, we will conduct duplicate independent data extraction, risk of bias assessment and evaluation of the quality of the evidence using the GRADE approach. ETHICS AND DISSEMINATION Our systematic review will evaluate the effects of β-blockers in adults with sepsis, comprehensively summarising and appraising the available evidence from randomised control trials. The results of this systematic review will help clinicians treating patients with sepsis to understand the potential role of β-blockade, and inform future research on this topic. Our findings will be disseminated through conference presentation and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42016036933.
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Affiliation(s)
- Erick H Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Simon J W Oczkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Emilie Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Population Health Research Institute, Hamilton, Ontario, Canada Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Richard Whitlock
- Population Health Research Institute, Hamilton, Ontario, Canada Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Francois Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada Centre de recherche du CHU de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Phillip J Devereaux
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Population Health Research Institute, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Marvanova P, Padrtova T, Pekarek T, Brus J, Czernek J, Mokry P, Humpa O, Oravec M, Jampilek J. Synthesis and Characterization of New 3-(4-Arylpiperazin-1-yl)-2-hydroxypropyl 4-Propoxybenzoates and Their Hydrochloride Salts. Molecules 2016; 21:molecules21060707. [PMID: 27258242 PMCID: PMC6273361 DOI: 10.3390/molecules21060707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/16/2016] [Accepted: 05/23/2016] [Indexed: 12/05/2022] Open
Abstract
Five new 3-(4-arylpiperazin-1-yl)-2-hydroxypropyl 4-propoxybenzoates were designed and synthesized as potential dual antihypertensive agents. The compounds were prepared as free bases and subsequently transformed to hydrochloride salts. The position of protonation of nitrogen atoms in the piperazine ring of hydrochloride salts was determined by means of 13C-CP/MAS and 15N-CP/MAS NMR and IR spectroscopy. Using these solid-state analytical techniques, it was found that both nitrogen atoms were protonated when excess hydrogen chloride was used for preparation of salts. On the other hand, when the equimolar amount of hydrogen chloride was used, piperazine nitrogen substituted by aryl was protonated.
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Affiliation(s)
- Pavlina Marvanova
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic.
| | - Tereza Padrtova
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic.
| | - Tomas Pekarek
- Zentiva k.s., U kabelovny 130, 10237 Prague 10, Czech Republic.
| | - Jiri Brus
- Institute of Macromolecular Chemistry, Academy of Sciences of the Czech Republic, Heyrovsky sq. 2, 16206 Prague 6, Czech Republic.
| | - Jiri Czernek
- Institute of Macromolecular Chemistry, Academy of Sciences of the Czech Republic, Heyrovsky sq. 2, 16206 Prague 6, Czech Republic.
| | - Petr Mokry
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic.
| | - Otakar Humpa
- CEITEC-Central European Institute of Technology, Masaryk University, Kamenice 753/5, 62500 Brno, Czech Republic.
| | - Michal Oravec
- Global Change Research Institute CAS, Belidla 986/4a, 60300 Brno, Czech Republic.
| | - Josef Jampilek
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Comenius University, Odbojarov 10, 83232 Bratislava, Slovakia.
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Selvaraj V, Manoharan KR. Prospective randomized study to compare between intravenous dexmedetomidine and esmolol for attenuation of hemodynamic response to endotracheal intubation. Anesth Essays Res 2016; 10:343-8. [PMID: 27212772 PMCID: PMC4864690 DOI: 10.4103/0259-1162.181226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Esmolol has an established role in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. We studied the effect of dexmedetomidine compared to that of esmolol in this study. Aim: To study the role of dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and oral endotracheal intubation compared to that of esmolol hydrochloride in patients posted for elective surgery under general anesthesia. Study Design: Prospective randomized study double-dummy blinding method. Materials and Methods: A total of 60 American Society of Anesthesiologists I patients, aged 18–60 years randomly divided into two groups; Group A patients received dexmedetomidine 1 mcg/kg diluted in 50 ml with normal saline and infused over 10 min before induction and also 20 ml of normal saline intravenous (IV) 2 min before endotracheal intubation. Group B patients received 50 ml IV infusion of normal saline over 10 min before induction and IV bolus of esmolol 0.5 mg/kg diluted in 20 ml with normal saline given 2 min before intubation. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before induction and after intubation at 1 min, 3 min, and 5 min after intubation. Statistical Analysis: Independent samples t-test and repeated measures of analysis of variance. Results: Dexmedetomidine group showed statistically significant reduction in all the study parameters at all study time intervals following intubation. While esmolol group showed significant attenuation of HR, SBP, and MAP following intubation but failed to produce significant reduction in DBP. Conclusion: Dexmedetomidine is more effective in attenuating the hemodynamic response to oral endotracheal intubation compared to that of esmolol hydrochloride.
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Affiliation(s)
- Venkatesh Selvaraj
- Department of Anaesthesiology, Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Porur, Chennai, Tamil Nadu, India
| | - Karthik Raj Manoharan
- Department of Anaesthesiology, Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Porur, Chennai, Tamil Nadu, India
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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Antihypertensives. Pediatr Crit Care Med 2016; 17:S101-8. [PMID: 26945324 DOI: 10.1097/pcc.0000000000000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hypertension remains a common condition in pediatric cardiac intensive care. The physiologic effects of hypertension in this population are complex and are impacted by patient age, comorbidities, and primary cardiac disease. The objective of this study is to review current pharmacotherapies for the management of systemic hypertension in the pediatric cardiac ICU. DATA SOURCES Relevant literature to the treatment of systemic hypertension in children was included. Specific focus was given to literature studying the use of therapies in critically ill children and those with heart disease. Reference textbooks and drug packaging inserts were used for drug-specific pediatric guidelines. STUDY SELECTION A search of MEDLINE, PubMed, and the Cochrane Database was performed to find literature about the management of hypertension in children. Metaanalyses and pediatric-specific studies were primarily considered and cross-referenced. Pertinent adult studies were included. DATA EXTRACTION Once the studies for inclusion were finalized, priority for data extraction was given to pediatric-specific studies that focused on children with heart disease and critical illness. CONCLUSIONS Systemic hypertension is common, and there is significant heterogeneity in the patient population with critical heart disease. There are limited large, prospective analyses of safety and efficacy for pediatric drug antihypertensive agents. Despite patient heterogeneity, most pharmacotherapies are safe and efficacious.
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Maurovich-Horvat P, Károlyi M, Horváth T, Szilveszter B, Bartykowszki A, Jermendy ÁL, Panajotu A, Celeng C, Suhai FI, Major GP, Csobay-Novák C, Hüttl K, Merkely B. Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: A randomized controlled clinical trial. J Cardiovasc Comput Tomogr 2015; 9:139-45. [DOI: 10.1016/j.jcct.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/24/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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Jankovic SM. Pharmacokinetics of selective β1-adrenergic blocking agents: prescribing implications. Expert Opin Drug Metab Toxicol 2014; 10:1221-9. [DOI: 10.1517/17425255.2014.937702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Padilla Ramos A, Varon J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep 2014; 16:450. [DOI: 10.1007/s11906-014-0450-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Preventive and Therapeutic Effects of a Beta Adrenoreceptor Agonist, Dobutamine, in Carrageenan-Induced Inflammatory Nociception in Rats. Inflammation 2014; 37:1814-25. [DOI: 10.1007/s10753-014-9912-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ghatak T, Samanta S. Methanol toxicity following esmolol infusion in a post-operative case of pheochromocytoma resection. Saudi J Anaesth 2013; 7:484-5. [PMID: 24348312 PMCID: PMC3858711 DOI: 10.4103/1658-354x.121062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tanmoy Ghatak
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Sukhen Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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Balik M, Rulisek J, Leden P, Zakharchenko M, Otahal M, Bartakova H, Korinek J. Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Reply to a letter to the authors. Wien Klin Wochenschr 2013; 126:246-7. [PMID: 24343046 DOI: 10.1007/s00508-013-0487-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 12/01/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Martin Balik
- Dept. of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U nemocnice 2, 120 00, Prague 2, Czech Republic,
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Improved Hemodynamics With a Novel Miniaturized Intra-aortic Axial Flow Pump in a Porcine Model of Acute Left Ventricular Dysfunction. ASAIO J 2013; 59:240-5. [DOI: 10.1097/mat.0b013e31828a6e74] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hoshi T, Sato A, Nishina H, Kakefuda Y, Wang Z, Noguchi Y, Aonuma K. Acute hemodynamic effects of landiolol, an ultra-short-acting beta-blocker, in patients with acute coronary syndrome: Preliminary study. J Cardiol 2012; 60:252-6. [DOI: 10.1016/j.jjcc.2012.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/17/2012] [Accepted: 06/03/2012] [Indexed: 11/30/2022]
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Fujii M, Chambers DJ. Cardioprotection with esmolol cardioplegia: efficacy as a blood-based solution. Eur J Cardiothorac Surg 2012; 43:619-27. [DOI: 10.1093/ejcts/ezs365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tang YH, Wang JY, Hu HH, Yao TW, Zeng S. Analysis of species-dependent hydrolysis and protein binding of esmolol enantiomers. J Pharm Anal 2012; 2:220-225. [PMID: 29403746 PMCID: PMC5760893 DOI: 10.1016/j.jpha.2012.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/09/2012] [Indexed: 11/15/2022] Open
Abstract
The stereoselective hydrolysis of esmolol in whole blood and in its separated components from rat, rabbit and human was investigated. Blood esterase activities were variable in different species in the order of rat>rabbit>human. Rat plasma showed the high esterase activity and had no stereoselectivity to enantiomers. Rabbit red blood cell (RBC) membrane, RBC cytosol and plasma all hydrolyzed esmolol but with different esterase activity, whereas the hydrolysis in RBC membrane and cytosol showed significant stereoselectivity towards R-(+)-esmolol. Esterase in RBC cytosol from human blood mainly contributed to the esmolol hydrolysis, which was demonstrated with no stereoselctivity. Esterase in human plasma showed a low activity, but a remarkable stereoselectivity with R-(+)-esmolol. In addition, the protein concentration affected the hydrolysis behavior of esmolol in RBC suspension. Protein binding of esmolol enantiomers in human plasma, human serum albumin (HSA) and α1-acid glycoprotein (AGP) revealed that there was a significant difference in bound fractions between two enantiomers, especially for AGP. Our results indicated that the stereoselective protein binding might play a role in the different hydrolysis rates of esmolol enantiomers in human plasma.
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Affiliation(s)
- Yi-Hong Tang
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
- Shanghai Institute of Technology, Shanghai 201418, People’s Republic of China
| | - Jun-Yan Wang
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
| | - Hai-Hong Hu
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
| | - Tong-Wei Yao
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
| | - Su Zeng
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
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Shen PH, Weitzel EK, Lai JT, Wormald PJ, Ho CS. Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial. Am J Rhinol Allergy 2012; 25:e208-11. [PMID: 22185726 DOI: 10.2500/ajra.2011.25.3701] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. METHODS A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. RESULTS Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p < 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). CONCLUSION Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.
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Affiliation(s)
- Ping-Hung Shen
- Department of Otolaryngology, Kuang-Tien General Hospital, Taichung, Taiwan
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Hanamoto H, Sugimura M, Morimoto Y, Kudo C, Boku A, Niwa H. Small bolus of esmolol effectively prevents sodium nitroprusside-induced reflex tachycardia without adversely affecting blood pressure. J Oral Maxillofac Surg 2012; 70:1045-51. [PMID: 22364858 DOI: 10.1016/j.joms.2011.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/27/2011] [Accepted: 12/30/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypotensive anesthesia with sodium nitroprusside (SNP) often is associated with reflex tachycardia. The purpose of this study was to investigate whether a small bolus of esmolol could counteract SNP-induced reflex tachycardia and sympathetic activation without affecting blood pressure. MATERIALS AND METHODS Using a time-series study design, 27 healthy young patients scheduled for mandibular osteotomy were enrolled in this study. General anesthesia was maintained with 2% sevoflurane and 67% nitrous oxide in oxygen. SNP was administered to decrease the mean arterial pressure to 55 to 65 mm Hg. When heart rate (HR) increased reflexively to higher than 95 beats/min from SNP-induced hypotension, esmolol 0.5 mg/kg was given. Blood pressure and HR were measured, and the low-frequency component (0.04 to 0.15 Hz) of systolic blood pressure variability and high-frequency component (0.15 to 0.4 Hz) of HR variability were calculated to evaluate the autonomic condition. Data were analyzed using 1-way analysis of variance after multiple comparisons or t test. P < .05 was considered statistically significant. RESULTS Of the 27 patients analyzed, 19 patients (70%) required esmolol. In these patients, SNP caused an increase in the low-frequency component of systolic blood pressure variability and a decrease in the high-frequency component of HR variability, leading to tachycardia (HR range, 95.9 ± 7.3 to 106.7 ± 7.4 beats/min; P < .001). Esmolol suppressed the effects of SNP on the low-frequency component of systolic blood pressure variability and high-frequency component of HR variability, resulting in an immediate decrease in HR to 86.9 ± 6.2 beats/min (P < .001), whereas mean arterial pressure remained unchanged. CONCLUSIONS A small bolus of esmolol can suppress reflex tachycardia without significantly changing mean arterial pressure. Thus, esmolol restores the autonomic imbalance induced by SNP during hypotensive anesthesia.
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Affiliation(s)
- Hiroshi Hanamoto
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan.
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Shibata S, Okamoto Y, Endo S, Ono K. Direct effects of esmolol and landiolol on cardiac function, coronary vasoactivity, and ventricular electrophysiology in guinea-pig hearts. J Pharmacol Sci 2012; 118:255-65. [PMID: 22293301 DOI: 10.1254/jphs.11202fp] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The ultra-short acting, selective β(1)-adrenergic antagonists landiolol and esmolol are widely used perioperatively; however, little is known about their acute direct actions on the heart. The current study utilized the Langendorff perfused heart system to measure changes in cardiac function and hemodynamics in response to each drug. Furthermore, electrophysiological analysis was performed on isolated ventricular myocytes. Direct application of esmolol significantly decreased systolic left ventricular pressure and heart rate at concentrations > 10 µM, while it dose-dependently increased coronary perfusion pressure. Esmolol also shortened the action potential duration (APD) in a concentration-dependent manner, an action maintained even when the delayed rectifier K(+) current or ATP sensitive K(+) current was blocked. Moreover, esmolol inhibited both the inward rectifier K(+) current (I(K1)) and the L-type Ca(2+) current (I(CaL)) and increased the outward current dose-dependently. In contrast, landiolol had minimal cardiac effects. In the Kyoto Model computer simulation, inhibition of either I(K1) or I(CaL) alone failed to shorten the APD; however, an additional increase in the time-independent outward current caused shortening of the APD, equal to that induced by esmolol. In conclusion, esmolol directly inhibits cardiac performance significantly more so than landiolol, an effect revealed to be at least in part mediated by esmolol-induced APD shortening.
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Affiliation(s)
- Shigehiro Shibata
- Department of Cell Physiology, Akita University Graduate School of Medicine, Japan
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Nikolaou NI, Koutouzis MJ, Christou A, Fournarakis GM, Patsilinakos SP, Rompola A, Maisel AS. B-type natriuretic peptide blood levels identify patients with non-ST elevation acute coronary syndromes at high risk for complications during intravenous beta-blocker infusion. ACTA ACUST UNITED AC 2011; 13:129-35. [PMID: 21539458 DOI: 10.3109/17482941.2011.567277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We hypothesized that measurement of B-type natriuretic peptide could identify patients with non-ST elevation acute coronary syndromes at high risk for complications during beta-blocker (esmolol) infusion. METHODS We reviewed the records of 340 consecutive patients admitted with a non-ST elevation acute coronary syndrome. Seventy three (47 males, aged 62 ± 14 years) received esmolol up to a maximum dose of 300 μg/ kg/min until the symptoms were relieved or an adverse event occurred. RESULTS The median infusion rate at steady state was 175 μg/kg/min (median infusion time 18 h). Infusion was halted in 14 patients. The frequency of drug discontinuation increased across admission BNP quartiles. BNP > 141 pg/ml at admission had a 95% predictive value for subsequent withdrawal of esmolol. The presence of BNP > 141 pg/ml in combination with systolic blood pressure < 130 mmHg and left ventricular ejection fraction < 50% identified a group of patients at high risk for drug interruption (interruption frequency = 83%, 95% CI: 55-95%). CONCLUSIONS In conclusion, BNP measurement in combination with systolic blood pressure and 2D echocardiography may identify patients with non-ST elevation acute coronary syndromes at high risk for adverse events during esmolol infusion.
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Affiliation(s)
- Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Hammer GB, Verghese ST, Drover DR, Yaster M, Tobin JR. Pharmacokinetics And Pharmacodynamics Of Fenoldopam Mesylate For Blood Pressure Control In Pediatric Patients. BMC Anesthesiol 2008; 8:6. [PMID: 18837982 PMCID: PMC2576052 DOI: 10.1186/1471-2253-8-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 10/06/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fenoldopam mesylate, a selective dopamine1-receptor agonist, is used by intravenous infusion to treat hypertension in adults. Fenoldopam is not approved by the FDA for use in children; reports describing its use in pediatrics are limited. In a multi-institutional, placebo controlled, double-blind, multi-dose trial we determined the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and side-effect profile of fenoldopam in children. METHODS Seventy seven (77) children from 3 weeks to 12 years of age scheduled for surgery in which deliberate hypotension would be induced were enrolled. Patients were randomly assigned to one of five, blinded treatment groups (placebo or fenoldopam 0.05, 0.2, 0.8, or 3.2 mcg/kg/min iv) for a 30-minute interval after stabilization of anesthesia and placement of vascular catheters. Following the 30-minute blinded interval, investigators adjusted the fenoldopam dose to achieve a target mean arterial pressure in the open-label period until deliberate hypotension was no longer indicated (e.g., muscle-layer closure). Mean arterial pressure and heart rate were continuously monitored and were the primary endpoints. RESULTS Seventy-six children completed the trial. Fenoldopam at doses of 0.8 and 3.2 mcg/kg/min significantly reduced blood pressure (p < 0.05) during the blinded interval, and doses of 1.0-1.2 mcg/kg/min resulted in continued control of blood pressure during the open-label interval. Doses greater than 1.2 mcg/kg/min during the open-label period resulted in increasing heart rate without additional reduction in blood pressure. Fenoldopam was well-tolerated; side effects occurred in a minority of patients. The PK/PD relationship of fenoldopam in children was determined. CONCLUSION Fenoldopam is a rapid-acting, effective agent for intravenous control of blood pressure in children. The effective dose range is significantly higher in children undergoing anesthesia and surgery (0.8-1.2 mcg/kg/min) than as labeled for adults (0.05-0.3 mcg/kg/min). The PK and side-effect profiles for children and adults are similar.
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Affiliation(s)
- Gregory B Hammer
- Departments of Anesthesia and Pediatrics, Stanford University School of Medicine, Stanford, USA.
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