Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery

Emergence from general anaesthesia and extubation are often accompanied by significant surges in heart rate and blood pressure. To document these changes and the efficacy of low-dose beta-blocker infusions in ameliorating these rises, we undertook a descriptive dose-ranging study comparing the use o...

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Main Authors: Lim, S. H., Chin, N. M., Tai, H. Y., Wong, M., LIN, Ting Kwong
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Language:English
Published: Institutional Knowledge at Singapore Management University 2000
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Online Access:https://ink.library.smu.edu.sg/soe_research/291
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spelling sg-smu-ink.soe_research-12902010-09-23T05:48:03Z Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery Lim, S. H. Chin, N. M. Tai, H. Y. Wong, M. LIN, Ting Kwong Emergence from general anaesthesia and extubation are often accompanied by significant surges in heart rate and blood pressure. To document these changes and the efficacy of low-dose beta-blocker infusions in ameliorating these rises, we undertook a descriptive dose-ranging study comparing the use of esmolol to placebo in patients emerging from neuro-anaesthesia. Materials and Methods: Thirty-six patients undergoing intracranial surgery were randomised to receive saline, esmolol 100 ?g/kg/min or 200 ?g/kg/min infusions. The number of patients developing severe hypertension or tachycardia in each group was compared using Fisher’s exact test. Results: Systolic blood pressure (SBP) and heart rate (HR) increased in all 3 groups during emergence and peaked at extubation. The proportion of patients with severe tachycardia or hypertension was reduced from 92% in the placebo group to 40% (P = 0.02) and 8% (P = 0.001) in the low and intermediate dose esmolol groups, respectively. Results were better in the intermediate dose group but the difference was not statistically significant. Two patients from the esmolol infusion groups required supplemental medication for bradycardia. Conclusion: Severe hypertension or tachycardia occurs in 92% of patients during extubation following neuro-anaesthesia and warrants the consideration of routine prophylaxis. Prophylactic esmolol infusion for the control of haemodynamic disturbances during extubation is feasible and safe. A modest level of obtundation is evident at 100 ?g/kg/min but a rate of 200 ?g/kg/min may prove to be more effective. 2000-01-01T08:00:00Z text https://ink.library.smu.edu.sg/soe_research/291 Research Collection School Of Economics eng Institutional Knowledge at Singapore Management University Econometrics Medicine and Health Sciences
institution Singapore Management University
building SMU Libraries
continent Asia
country Singapore
Singapore
content_provider SMU Libraries
collection InK@SMU
language English
topic Econometrics
Medicine and Health Sciences
spellingShingle Econometrics
Medicine and Health Sciences
Lim, S. H.
Chin, N. M.
Tai, H. Y.
Wong, M.
LIN, Ting Kwong
Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
description Emergence from general anaesthesia and extubation are often accompanied by significant surges in heart rate and blood pressure. To document these changes and the efficacy of low-dose beta-blocker infusions in ameliorating these rises, we undertook a descriptive dose-ranging study comparing the use of esmolol to placebo in patients emerging from neuro-anaesthesia. Materials and Methods: Thirty-six patients undergoing intracranial surgery were randomised to receive saline, esmolol 100 ?g/kg/min or 200 ?g/kg/min infusions. The number of patients developing severe hypertension or tachycardia in each group was compared using Fisher’s exact test. Results: Systolic blood pressure (SBP) and heart rate (HR) increased in all 3 groups during emergence and peaked at extubation. The proportion of patients with severe tachycardia or hypertension was reduced from 92% in the placebo group to 40% (P = 0.02) and 8% (P = 0.001) in the low and intermediate dose esmolol groups, respectively. Results were better in the intermediate dose group but the difference was not statistically significant. Two patients from the esmolol infusion groups required supplemental medication for bradycardia. Conclusion: Severe hypertension or tachycardia occurs in 92% of patients during extubation following neuro-anaesthesia and warrants the consideration of routine prophylaxis. Prophylactic esmolol infusion for the control of haemodynamic disturbances during extubation is feasible and safe. A modest level of obtundation is evident at 100 ?g/kg/min but a rate of 200 ?g/kg/min may prove to be more effective.
format text
author Lim, S. H.
Chin, N. M.
Tai, H. Y.
Wong, M.
LIN, Ting Kwong
author_facet Lim, S. H.
Chin, N. M.
Tai, H. Y.
Wong, M.
LIN, Ting Kwong
author_sort Lim, S. H.
title Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
title_short Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
title_full Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
title_fullStr Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
title_full_unstemmed Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
title_sort prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery
publisher Institutional Knowledge at Singapore Management University
publishDate 2000
url https://ink.library.smu.edu.sg/soe_research/291
_version_ 1770569101046972416