Korean J Anesthesiol.  1998 Mar;34(3):526-530. 10.4097/kjae.1998.34.3.526.

Appropriate Dose of Esmolol for Protection of Tachycardia and Hypertension by Endotracheal Intubation

• Kang KC
• Im J
• Joo J

• KMID: 2032414
• DOI: http://doi.org/10.4097/kjae.1998.34.3.526

Abstract

BACKGROUND
Esmolol has been recommended to prevent tachycardia and hypertension induced by tracheal intubation in several studies, but these studies are based on mean values of changes of vital signs. Therefore, the recommended doses are not guaranteed to be precise effective dose.
METHODS
According to esmolol dose, 140 patients were randomly alldegrees Cated to 7 groups of 20 patients. After intravenous thiopental and vecuronium followed by mask ventilation of 3 minutes with enflurane, nitrous oxide and oxygen, one of the dosages of esmolol 0, 0.2, 0.3, 0.45, 0.5, 0.6, 0.8 or 1.0 mg/kg was administered. Ninty seconds later, tracheal intubation by direct laryngoscopy was performed. After then heart rate was monitored continuously and blood pressure was measured 5 times at intervals of 1 minute. The highest heart rate and systolic blood pressure were recorded. If the highest heart rate was beyond 100/min or highest systolic blood pressure was beyond 170 mmHg, we regarded this cases as 'unprotected' case. By logistic regression, we calculated the doses of esmolol which reduce the incidence of tachycardia, systolic hypertension and unprotection below 5% respectively.
RESULTS
The appropriate doses of esmolol for prevention of tachycardia, systolic hypertension and 'unprotection' were 0.95 mg (95% CI: 0.77~1.33 mg), 0.38 mg (95% CI: 0.21~1.05 mg) and 0.93 mg (95% CI: 0.78~1.23 mg) respectively.
CONCLUSIONS
In anesthetic induction and tracheal intubation with thiopental and vecuronium, esmolol 0.78~1.23 mg/kg was appropriate for preventiion of tachycardia ( > 100 bpm) and systolic hypertension ( > 170 mmHg).

Keyword

Intubation, tracheal: complications; Pharmacology: esmolol

MeSH Terms

Blood Pressure
Enflurane
Heart Rate
Humans
Hypertension*
Incidence
Intubation
Intubation, Intratracheal*
Laryngoscopy
Logistic Models
Masks
Nitrous Oxide
Oxygen
Tachycardia*
Thiopental
Vecuronium Bromide
Ventilation
Vital Signs
Enflurane
Nitrous Oxide
Oxygen
Thiopental
Vecuronium Bromide