Korean J Anesthesiol.  1999 Feb;36(2):225-231. 10.4097/kjae.1999.36.2.225.

ED95 of Esmolol for Protection of Tachycardia and Systolic Hypertension by Endotracheal Intubation in Anesthetic Induction with Enflurane, Nitrous Oxide, Thiopental and Fentanyl

• Kang K
• Yang BY

• KMID: 2091345
• DOI: http://doi.org/10.4097/kjae.1999.36.2.225

Abstract

BACKGROUND: Esmolol has been used combined with small dose of fentanyl to prevent tachycardia and hypertension induced by tracheal intubation, but there has been few studies about the appropriate doses of esmolol when used combined with fentanyl.
METHODS
According to esmolol dose, 140 patients were randomly allocated to 7 groups of 20 patients. After 2 microgram/kg of fentanyl, 4 mg/kg of thiopental and 0.12 mg/kg of vecuronium were intravenously administered, mask ventilation for 3 minutes with enflurane, nitrous oxide and oxygen was followed. Then one of the doses of esmolol, 0, 0.2, 0.3, 0.45, 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 with 1 minute interval. The highest heart rate and systolic blood pressure were recorded. We calculated the doses of esmolol which reduce the incidence of tachycardia (increased above 100 bpm or by more than 40% of preinduction level) and systolic hypertension (increased above 170 mmHg or by more than 40% of preinduction level) below 5% respectively.
RESULTS
The ED95 of esmolol for prevention of tachycardia induced by tracheal intubation was 0.56 mg/kg (95% CI: 0.44-0.81 mg/kg). But the incidence of systolic hypertension was so low even without esmolol injection that the esmolol dose was not significant factor.
CONCLUSIONS
In anesthetic induction and tracheal intubation with enflurane, nitrous oxide, thiopental, vecuronium, and fentanyl 2 microgram/kg, esmolol 0.56 mg/kg was ED95 of preventing tachycardia. But the incidence of systolic hypertension was acceptably low even without esmolol injection.

Keyword

Intubation, tracheal, complications; Pharmacology, esmolol, fentanyl

MeSH Terms

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