Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: A meta-analysis

• Published in: Acta anaesthesiologica Scandinavica Vol. 45; no. 8; pp. 1011 - 1022
• Main Authors: Figueredo, E., Garcia-Fuentes, E. M.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01.09.2001; Blackwell
• Subjects: Adrenergic beta-Antagonists - pharmacology; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesia: induction; Biological and medical sciences; Blood Pressure - drug effects; complications: hypertension; Dose-Response Relationship, Drug; esmolol; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Heart Rate - drug effects; Hemodynamics - drug effects; Humans; intubation; Intubation, Intratracheal; intubation, tracheal: cardiovascular responses; Laryngoscopy; Medical sciences; Propanolamines - pharmacology; sympathetic nervous system: beta adrenergic antagonists; sympathetic nervous system: beta adrenergic antagonists, esmolol; tachycardia; tracheal: cardiovascular responses; Human; Hypertension; Intravenous administration; Induction; Esmolol; Cardiovascular disease; General anesthesia; Posology; Laryngoscopy; Metaanalysis; Chemotherapy; Tachycardia; Bolus injection; β1-Adrenergic receptor; Treatment; Perfusion; Complication; Application method; Antagonist; Intubation; Trachea; Beta blocking agent
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2001.450815.x

Background: Adrenergic stress response induced by laryngoscopy and tracheal intubation (LTI) appears to be attenuated by esmolol, but its potential clinical benefits have not been fully weighed against possible adverse effects. Methods: A systematic search up to May 2000 was performed using MEDLINE, EMBASE, LILACS, Cochrane library, manual searching and bibliographies in all languages. All randomised comparisons of esmolol with placebo on the haemodynamic changes elicited by LTI were obtained. Trials were included in the present meta‐analysis if they recorded heart rate (HR), systolic pressure (SBP), mean arterial pressure (MAP) or diastolic pressure (DBP) at three different stages: pre‐induction, immediately prior to intubation, and in the post‐intubation period. Weighted mean differences (WMD) and 95% confidence intervals (CI) of the changes in the haemodynamic variables between treatment and placebo groups were calculated. Results: Of 72 publications identified, 38 randomised controlled trials containing a total of 2009 patients were finally included. Eleven different regimens and doses of esmolol demonstrated effectiveness in the attenuation of HR and BP after LTI in a dose‐dependent manner. The most effective regimen was a loading dose of 500 μg · kg−1 · min−1 over 4 min followed by continuous infusion dose of 200–300 μg · kg−1 · min−1[WMD: 20.2 bpm (95% CI: 15.6 to 24.7)]. High bolus dose (200 mg) of esmolol produced a considerable decrease in DBP [WMD 10.1 mmHg (95% CI: 7.3 to 12.8)]. Conclusion: Esmolol is effective, in a dose‐dependent manner, in the attenuation of the adrenergic response to LTI. To minimise its adverse effects it should be administered, when considered clinically appropriate, as a continuous infusion regimen.