Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia

Abstract

Laryngomicroscopy is a short-lasting procedure, which causes considerable hemodynamic and ECG changes. Therefore it sets specific demands on anesthetic care. In this double-blind randomized work, we studied hemodynamic and ECG changes in patients during laryngomicroscopy in jet ventilation under propofol-alfentanil anesthesia with and without esmolol, a short-acting beta1-adrenergic receptor blocking agent. Forty ASA class I-II patients were allocated to receive either esmolol 1 mg.kg-1 + 200 micrograms.kg-1.min-1 (the esmolol group) or saline (the control group) (mean age +/- SD 36 +/- 12 yrs in the esmolol group and 39 +/- 9 yrs in the control group). The heart rate and arterial pressure were measured non-invasively and ECG was analyzed with the aid of a microcomputer. In the control group, neither the heart rate nor the QTc interval of the ECG did change significantly when compared with the baseline values. In the presence of esmolol, the heart rate decreased and the QTc interval shortened during the procedure. Arterial pressure increased in the control group, but not in the esmolol group, when compared with the baseline values. No cardiac arrhythmias occurred in either of the groups. On the basis of the present study, propofol-alfentanil anesthesia combined with esmolol is a satisfactory method to meet specific demands of laryngomicroscopy in young and middle-aged ASA I-II patients. However, a combination of propofol and esmolol showed a tendency to decrease both the heart rate and arterial pressure and a caution is necessary when the combination were used in elderly patients.