Journal of Cardiothoracic and Vascular Anesthesia
Volume 24, Issue 2 , Pages 219-229 , April 2010

Esmolol Reduces Perioperative Ischemia in Noncardiac Surgery: A Meta-analysis of Randomized Controlled Studies

  • Giovanni Landoni, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • Corresponding Author InformationAddress reprint requests to Giovanni Landoni, MD, Department of Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Via Olgettina 60, Milano 20132, Italy
    • ,
  • Stefano Turi, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • ,
  • Giuseppe Biondi-Zoccai, MD

      Affiliations

    • Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy
    • ,
  • Elena Bignami, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • ,
  • Valentina Testa, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • ,
  • Ilaria Belloni, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • ,
  • Guglielmo Cornero, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
    • ,
  • Alberto Zangrillo, MD

      Affiliations

    • Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy

References 

  1. Auerbach AD, Goldman L. Beta-blockers and reduction of cardiac events in noncardiac surgery: Scientific review. JAMA. 2002;287:1435–1444
  2. Zaugg M, Tagliente T, Lucchinetti E, et al. Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology. 1999;91:1674–1686
  3. McGory ML, Maggard MA, Ko CY. A meta-analysis of peri-operative beta-blockade: What is the actual risk reduction?. Surgery. 2005;138:171–179
  4. Wiesbauer F, Schlager O, Domanovits H, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity: A systematic review and meta-analysis. Anesth Analg. 2007;104:27–41
  5. Feringa HH, Bax JJ, Boersma E, et al. High dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation. 2006;114:1344–1349
  6. Killingsworth CR, Wei CC, Dell'Italia LJ, et al. Short-acting beta-adrenergic antagonist esmolol given at reperfusion improves survival after prolonged ventricular fibrillation. Circulation. 2004;109:2469–2474
  7. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) (American College of Cardiology/American Heart Association Task Force on Practice Guidelines). Anesth Analg. 2008;106:685–712
  8. Biccard BM, Sear JW, Foex P. Acute perioperative beta-blockade in intermediate-risk patients. Anaesthesia. 2006;61:924–931
  9. POISE Study GroupDevereaux PJ, Yang H, et al. Effects of extended release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomised controlled trial. Lancet. 2008;371:1839–1847
  10. Fita G, Gomar C, Rovira I. Esmolol in anesthesiology: Pharmacology and indications. Rev Esp Anestesiol Reanim. 1999;46:401–414
  11. Ravussin P. Characteristics and clinical use of esmolol. Minerva Anestesiol. 1992;58:77–79
  12. Celebi N, Artukoglu F, Dal D, et al. Effect of hypotensive anesthesia on cognitive functions (A comparison of esmolol and remifentanil during tympanoplasty). Saudi Med J. 2007;28:1357–1361
  13. Louizos AA, Hadzilia SJ, Davilis DI, et al. Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers. Ann Otol Rhinol Laryngol. 2007;116:107–111
  14. Kovac AL, Masiongale A. Comparison of nicardipine versus esmolol in attenuating the hemodynamic responses to anesthesia emergence and extubation. J Cardiothorac Vasc Anesth. 2007;21:45–50
  15. Mengistu AM, Wolf MW, Boldt J, et al. Influence of controlled hypotension using esmolol and sodium nitroprusside on natriuretic peptides in patients undergoing endonasal sinus surgery. Eur J Anaesthesiol. 2007;24:529–534
  16. Chia YY, Chan MH, Ko NH, et al. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004;93:799–805
  17. White PF, Wang B, Tang J, et al. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesth Analg. 2003;97:1633–1638
  18. Orme R, Leslie K, Umranikar A, et al. Esmolol and anesthetic requirement for loss of responsiveness during propofol anesthesia. Anesth Analg. 2002;94:112–116
  19. Maguire A, Thompson JP, Guest C, et al. Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double-lumen endobronchial intubation. Anaesthesia. 2001;56:319–325
  20. Coloma M, Chiu JW, White PF, et al. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg. 2001;92:352–357
  21. Lim SH, Chin NM, Tai HY, et al. Prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery. Ann Acad Med Singapore. 2000;29:447–451
  22. Atlee JL, Dhamee MS, Olund TL, et al. The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation. Anesth Analg. 2000;90:280–285
  23. Raby KE, Brull SJ, Timimi F, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg. 1999;88:477–482
  24. Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia. Acta Anaesthesiol Belg. 1998;49:123–132
  25. Van Den Berg AA. Use of esmolol to attenuate hemodynamic responses during cataract extraction. Middle East J Anesthesiol. 1998;14:231–248
  26. Thompson JP, West KJ, Hill AJ. The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol. Anaesthesia. 1997;52:790–794
  27. Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the heart rate, arterial pressure and electrocardiographic changes during laryngomicroscopy. Acta Anaesthesiol Scand. 1997;41:371–375
  28. Sharma S, Mitra S, Grover VK, et al. Esmolol blunts the haemodynamic responses to tracheal intubation in treated hypertensive patients. Can J Anaesth. 1996;43:778–782
  29. Korpinen R, Saarnivaara L, Siren K. QT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: Comparative effects of alfentanil and esmolol. Acta Anaesthesiol Scand. 1995;39:809–813
  30. Singh H, Vichitvejpaisal P, Gaines GY, et al. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. J Clin Anesth. 1995;7:5–8
  31. Fuhrman TM, Ewell CL, Pippin WD, et al. Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation. J Clin Anesth. 1992;4:444–447
  32. Chung KS, Sinatra RS, Halevy JD, et al. A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction. Can J Anaesth. 1992;39:774-749
  33. Blau WS, Kafer ER, Anderson JA. Esmolol is more effective than sodium nitroprusside in reducing blood loss during orthognathic surgery. Anesth Analg. 1992;75:172–178
  34. Kovac AL, Bennets PS, Ohara S, et al. Effect of esmolol on hemodynamics and intraocular pressure response to succinylcholine and intubation following low-dose alfentanil premedication. J Clin Anesth. 1992;4:315–320
  35. Singh PP, Dimich I, Sampson I, et al. A comparison of esmolol and labetalol for the treatment of perioperative hypertension in geriatric ambulatory surgical patients. Can J Anaesth. 1992;39:559–562
  36. Vucevic M, Purdy GM, Ellis FR. Esmolol hydrochloride for management of the cardiovascular stress responses to laryngoscopy and tracheal intubation. Br J Anaesth. 1992;68:529–530
  37. Mion G, Ruttimann M, Descraques C, et al. Bolus esmolol prior to tracheal intubation of the elderly patient. Cah Anesthesiol. 1992;40:95–99
  38. Smith I, Van Hemelrijck J, White PF. Efficacy of esmolol versus alfentanil as a supplement to propofol-nitrous oxide anesthesia. Anesth Analg. 1991;73:540–546
  39. Helfman SM, Gold MI, DeLisser EA, et al. Which drug prevents tachycardia and hypertension associated with tracheal intubation: Lidocaine, fentanyl, or esmolol?. Anesth Analg. 1991;72:482–486
  40. Kapnoudhis P, Vaghadia H, Jenkins LC, et al. Esmolol versus fentanyl for preventing haemodynamic response to intubation in cardiovascular disease. Can J Anaesth. 1990;37:145
  41. Gibson BE, Black S, Maass L, et al. Esmolol for the control of hypertension after neurologic surgery. Clin Pharmacol Ther. 1988;44:650–653
  42. Ozturk T, Kaya H, Aran G, et al. Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy. Br J Anaesth. 2008;100:211–214
  43. Collard V, Mistraletti G, Taqi A, et al. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg. 2007;105:1255–1262
  44. Suzuki S, Nonaka A, Abe F. Effect of esmolol on cardiovascular responses induced by scopolamine butylbromide. Masui. 2005;54:1277–1281
  45. Hussain AM, Sultan ST. Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation. J Coll Physicians Surg Pak. 2005;15:454–457
  46. Fernandez-Galinski S, Bermejo S, Mansilla R, et al. Comparative assessment of the effects of alfentanil, esmolol or clonidine when used as adjuvants during induction of general anaesthesia. Eur J Anaesthesiol. 2004;21:476–482
  47. Boussofara M, Chrayti H, Bracco D, et al. Comparison of three protocols in the control of cardiovascular response to suspended laryngoscopy in ENT surgery. Tunis Med. 2004;82:19–24
  48. Piper SN, Haisch G, Kumle B, et al. Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2003;38:781–786
  49. Wang YQ, Guo QL, Xie D. Effects of different doses of esmolol on cardiovascular responses to tracheal extubation. Hunan Yi Ke Da Xue Xue Bao. 2003;28:259–262
  50. Grillo P, Bruder N, Auquier P, et al. Esmolol blunts the cerebral blood flow velocity increase during emergence from anesthesia in neurosurgical patients. Anesth Analg. 2003;96:1145–1149
  51. Menigaux C, Guignard B, Adam F, et al. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth. 2002;89:857–862
  52. Boussofara M, Braco D, Kaddour C, et al. Control of hemodynamic variations secondary to suspension microlaryngoscopy. Tunis Med. 2001;79:503–507
  53. Bensky KP, Donahue-Spencer L, Hertz GE, et al. The dose-related effects of bolus esmolol on heart rate and blood pressure following laryngoscopy and intubation. AANA J. 2000;68:437–442
  54. Zalunardo MP, Zollinger A, Szelloe P, et al. Cardiovascular stress protection following anesthesia induction (Comparison of clonidine and esmolol). Anaesthesist. 2001;50:21–25
  55. Campagni MA, Howie MB, White PF, et al. Comparative effects of oral clonidine and intravenous esmolol in attenuating the hemodynamic response to epinephrine injection. J Clin Anesth. 1999;11:208–215
  56. Balser JR, Martinez EA, Winters BD, et al. Beta-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. Anesthesiology. 1998;89:1052–1059
  57. Koivusalo AM, Scheinin M, Tikkanen I, et al. Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand. 1998;42:510–517
  58. Ayuso A, Luis M, Sala X, et al. Effects of anesthetic technique on the hemodynamic response to microlaryngeal surgery. Ann Otol Rhinol Laryngol. 1997;106:863–868
  59. Van den Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery (A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given IV with induction of anaesthesia). Eur J Anaesthesiol. 1997;14:134–147
  60. Kindler CH, Schumacher PG, Schneider MC, et al. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: A double-blind, controlled clinical trial. J Clin Anesth. 1996;8:491–496
  61. Feng CK, Chan KH, Liu KN, et al. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34:61–67
  62. Doblar DD, Lim YC, Baykan N, et al. A comparison of alfentanil, esmolol, lidocaine, and thiopental sodium on the hemodynamic response to insertion of headrest skull pins. J Clin Anesth. 1996;8:31–35
  63. Sharma S, Ghani AA, Win N, et al. Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation. Med J Malaysia. 1995;50:372–376
  64. Boezaart AP, Van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42:373–376
  65. Schäffer J, Karg C, Piepenbrock S. Esmolol as a bolus for prevention of sympathetic adrenergic reactions following induction of anesthesia. Anaesthesist. 1994;43:723–729
  66. Yuan L, Chia YY, Jan KT, et al. The effect of single bolus dose of esmolol for controlling tachycardia and hypertension during laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1994;32:147–152
  67. Alexander R, Binns J, Hetreed M. A controlled trial of the effects of esmolol on cardiac function. Br J Anaesth. 1994;72:594–595
  68. Ornstein E, Young WL, Ostapkovich N, et al. Deliberate hypotension in patients with intracranial arteriovenous malformations: Esmolol compared with isoflurane and sodium nitroprusside. Anesth Analg. 1991;72:639–644
  69. Gaubatz CL, Wehner RJ. Evaluation of esmolol and fentanyl in controlling increases in heart rate and blood pressure during endotracheal intubation. Anesth Analg. 1991;59:91–96
  70. Ebert TJ, Bernstein JS, Stowe DF, et al. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth. 1990;2:243–252
  71. Kanitz DD, Ebert TJ. Intraoperative use of bolus doses of esmolol to treat tachycardia. J Clin Anesth. 1990;2:238–242
  72. Parnass SM, Rothenberg DM, Kerchberger JP, et al. A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth. 1990;2:232–237
  73. Ebert JP, Pearson JD, Gelman S, et al. Circulatory responses to laryngoscopy: The comparative effects of placebo, fentanyl and esmolol. Can J Anaesth. 1989;36:301–306
  74. Gold MI, Sacks DJ, Grosnoff DB, et al. Use of esmolol during anesthesia to treat tachycardia and hypertension. Anesth Analg. 1989;68:101–104
  75. Ornstein E, Matteo RS, Weinstein JA, et al. A controlled trial of esmolol for the induction of deliberate hypotension. J Clin Anesth. 1988;1:31–35
  76. Liu PL, Gatt S, Gugino LD, et al. Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine. Can Anaesth Soc J. 1986;33:556–562
  77. Higgins JPT, Green S. The Cochrane Collaboration Handbook for Systematic Reviews of Interventions 4.2.5. Accessed August 30, 2009 http://www.cochrane.org/resources/handbook/index.htm
  78. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: The QUORUM statement (Quality of reporting of meta-analyses). Lancet. 1999;354:1896–1900
  79. Devereaux PJ, Beattie WS, Choi PT, et al. How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? (Systematic review and meta-analysis of randomised controlled trials). BMJ. 2005;331:313–321
  80. Johansen JW, Flaishon R, Sebel PS. Esmolol reduces anesthetic requirement for skin incision during propofol/nitrous oxide/morphine anesthesia. Anesthesiology. 1997;86:364–371
  81. Oda Y, Nishikawa K, Hase I, et al. The short-acting beta1-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane anesthesia. Anesth Analg. 2005;100:733–737
  82. Zangrillo A, Turi S, Crescenzi G, et al. Esmolol reduces peri-operative myocardial ischemia in cardiac surgery (A meta-analysis of randomized controlled studies). J Cardiothorac Vasc Anesth. 2009;23:625–632
  83. Venkataraman R. Vascular surgery critical care: Perioperative cardiac optimization to improve survival. Crit Care Med. 2006;34:200–207
  84. Chen ZM, Pan HC, Chen YP, et al. COMMIT Collaborative Group Early intravenous than oral metoprolol in 45852 patients with acute myocardial infarction: randomized placebo controlled-trial. Lancet. 2005;366:1622–1632

PII: S1053-0770(09)00286-9

doi: 10.1053/j.jvca.2009.07.008

Journal of Cardiothoracic and Vascular Anesthesia
Volume 24, Issue 2 , Pages 219-229 , April 2010

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