Can esmolol manage surgically-induced tachycardia? Bolus esmolol treatment of intra-operative tachycardia due to surgical stimulation.

A double-blind, randomised study was conducted to examine the efficacy of a single bolus dose of esmolol in treating surgically-induced tachycardia. Anaesthetic technique was identical in all patients, and consisted of premedication with midazolam and glycopyrronium, induction with thiopentone followed by suxamethonium, tracheal intubation, and maintenance with isoflurane 0.6% (end-tidal) and 60% nitrous oxide in oxygen. Forty-eight patients developed a heart rate of greater than 95 beats/minute or 20% more than pre-induction values at an average time of 34 minutes after tracheal intubation and received placebo (15 patients), esmolol 50 mg (16 patients), or esmolol 100 mg (17 patients). Controlled intervention was instituted if heart rate or blood pressure was not adequate. Both 50 and 100 mg of esmolol resulted in lower heart rates compared to placebo (p less than 0.05), with no difference between the two esmolol groups (p greater than 0.05). Patients who received placebo had more episodes of medical intervention than those given esmolol (p less than 0.05). No adverse effects occurred in any patient.