THE PRINCIPLES OF USING ESMOLOL IN THE PRACTICE OF AN ANESTHESIOLOGIST AND AN INTENSIVE CARE PHYSICIAN
ARTICLE PDF (Українська)

Keywords

selective beta-1-blocker esmolol, anesthesiology and intensive care

How to Cite

Cherniy, V. I., Chernii, T. V., & Shestak, N. (2021). THE PRINCIPLES OF USING ESMOLOL IN THE PRACTICE OF AN ANESTHESIOLOGIST AND AN INTENSIVE CARE PHYSICIAN. Clinical and Preventive Medicine, (2), 77-85. https://doi.org/10.31612/2616-4868.2(16).2021.10

Abstract

Aim of the study: to analyze the problem of using the beta-1-blocker esmolol for anesthetic management and intensive care from the sources of the modern available literature.

Materials and methods. Bibliosemantic, comparative and systems analysis. The proposed recommendations are based on data from the analysis of modern literature, the results of randomized studies and meta-analyzes devoted to the study of the problem of using the beta-1-blocker esmolol for anesthetic management and intensive care.

Results and discussion. Esmolol is the only ultrashort-acting selective beta-blocker for parenteral administration, which selectively blocks beta-1-adrenergic receptors mediating the cardiac stimulating effect of catecholamines. To a lesser extent, it affects the β2-adrenergic receptors of the bronchi and smooth muscles. At doses above 300 μg/kg per minute, the β1-selectivity of esmolol decreases, the drug competitively blocks β1- and β2-adrenergic receptors. Esmolol is most indicated in anesthetic practice for limiting the endocrine-metabolic response, reducing the risk of cardiac complications, reducing pain intensity, controlling hemodynamics, including ensuring controlled hypotension. The features of the pharmacokinetics of esmolol make it possible to accurately modulate the degree and duration of the decrease in heart rate and blood pressure, depending on the clinical situation, and make esmolol an "ideal" cardiac drug.

Conclusion. The use of ultrashort-acting beta-blockers increases the efficiency and safety of anesthesia, especially in high-risk patients, and creates the prerequisites for ensuring the best treatment results for patients in various fields of surgery.

https://doi.org/10.31612/2616-4868.2(16).2021.10
ARTICLE PDF (Українська)

References

Nykonov, V .V., Sokolov, A.S., Kynoshenko, E.Y. (2018). Mozhlyvosti zastosuvannya kardioselektyvnykh parenteralʹnykh beta-blokatoriv u medytsyni neotlozhnykh staniv [Possibilities of application of cardioselective parenteral beta-blockers in emergency medicine]. Emergency medicin, №1(88) [in Ukrainian].

Maurovich-Horvat, P., Károlyi, M., Horváth, T. et al. (2015). Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angio–graphy: a randomized controlled clinical trial. J. Cardiovasc. Comput. Tomogr, Mar-Apr. 9(2), 139-45. doi: 10.1016/j.jcct.2015.02.001.

Rosens Emergency Medicine Concepts and Clinical Practice (2017). 9th Edition. Judith Tintinalli.

Kirchhof, P., Benussi S., Kotecha D. at al. 2016. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J, 37(38), 2893-2962.

Bulent Gorenek , Antonio Pelliccia, Emelia J Benjamin, Giuseppe Boriani et al. (2017). European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Review Eur J Prev Cardiol, Jan. 24(1), 4-40.

January, C.T., Wann, L.S., Alpert, J.S. et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol.

Efe, E.M., Bilgin, B.A., Alanoglu, Z., Akbaba, M., Den–ker, C. (2014). Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft. Revista Brasileira de Anestesiologia, 64(4), 247-252. https://dx.doi.org/10.1016/j.bjane.2013.07.003.

Frendl, G., Sodickson, A.C., Chung, M.K. et al. (2014). AATS Guidelines for the Prevention and Management of Peri-Operative Atrial Fibrillation and Flutter (POAF) for Thoracic Surgical Procedures. The Journal of thoracic and cardiovascular surgery, 148(3), e153-e193. doi: 10.1016/j.jtcvs.2014.06.036.

Walls, R., Hockberger, R., Gausche-Hill, M. (2017). Rosen’s Emergency Medicine — Concepts and Clinical Practice E-Book (Rosens Emergency Medicine Concepts and Clinical Practice) 9th Edition, Kindle Edition Elsevier. Amazon Digital Services LLC.

Trekova, N.A., Aksel'rod, B.A., Tolstova, I.A., Guleshov, V.A., Poplavskiy, I.V., Gus'kov, D.A. (2012). Effektivnost' i upravlyayemost' adrenergicheskoy blokady esmololom (breviblok) pri operatsiyakh na serdtse i aorte [Efficiency and controllability of adrenergic blockade with esmolol (breviblock) in operations on the heart and aorta]. Anesthesiology and resuscitation, 2.[in Russian].

Lee, S-J., Lee, J-N. (2010). The effect of perioperative esmolol infusion on thepostoperative nausea, vomiting and pain after laparoscopic appendectomy. Korean J Anesthesiol., 59(3), 179-184.

Shawn Bryant Collins, Ian Hewer (2015). Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review AANA Journal, June, 83.

Kobelyatskiy, YU.YU., Yovenko, I.A. (2010). Ispol'zovaniye esmolola v anesteziologii: sovremennyye tendentsii i sobstvennyy opyt [The use of esmolol in anesthesiology: current trends and personal experience] . Emergency Medicine, 1 (26).

Cherniy, V.I., Denysenko, A.I. (2020). Suchasni vozmozhnosty yspolʹzovanye nepryamoyi kalorimetriyi u perioperatsiynomu enerhomonitorinhu [Modern possibilities of using indirect calorimetry in perioperative energy monitoring]. Clinical and preventive medicine, 2, 12, 79-89. [in Ukrainian].

Richard Watts, Venkatesan Thiruvenkatarajan, Marni Calvert, Graeme Newcombe, and Roelof M. van Wijk (2017). The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol,. Jan-Mar., 33(1), 28–39. doi: 10.4103/0970-9185.202182.

Demosthenes G. Katritsis, (Chair), Giuseppe Boriani , Francisco G. Cosio et al. (2018). European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). European Heart Journal, 39, 1442–1445. Retrieved from: doi:10.1093/eurheartj/ehw455

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.