British Journal of Anaesthesia, 2002, Vol. 89, No. 6 857-862
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Esmolol prevents movement and attenuates the BIS response to orotracheal intubation
1 Département d’Anesthésie-Réanimation, Ambroise Pare Hôpital, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France. 2 Outcomes Research® Institute Institute and Department of Anesthesiology, University of Louisville, Kentucky, USA; Ludwig Boltzmann Anesthesia Institute, University of Vienna, Vienna, Austria marcel.chauvin@apr.ap-hop-paris.fr
Declaration of interest. Supported by NIH Grant GM 58273 (Bethesda, MD, USA), the Joseph Drown Foundation (Los Angeles, CA, USA), and the Commonwealth of Kentucky Research Challenge Trust Fund (Louisville, KY, USA). None of the authors has any personal financial interest in this research.
Background. Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting ß1-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation.
Methods. Fifty patients were randomly allocated, in a double-blind fashion, to receive esmolol 1 mg kg–1 followed by 250 µg kg–1 min–1 or saline (control). Esmolol or saline was started 6 min after a target-controlled infusion (TCI) of propofol (effect-site concentration 4 µg ml–1). After loss of consciousness, and before administration of vecuronium 0.1 mg kg–1, a tourniquet was applied to one arm and inflated to 150 mm Hg greater than systolic pressure. Eleven minutes after the TCI began, the trachea was intubated; gross movement within the first min after orotracheal intubation was recorded. BIS was recorded at 10-s intervals. Mean arterial pressure (MAP) and heart rate were measured non-invasively every min.
Results. There were no intergroup differences in BIS, heart rate or MAP before laryngoscopy. BIS increased significantly after orotracheal intubation (compared with the pre-laryngoscopy values) in the control group only, with a maximum increase of 40 (SD 18)% vs 8 (11)% in the esmolol group (P<0.01). Maximum changes in heart rate [45 (19)% vs 23 (14)%] and MAP [62 (24)% vs 45 (23)%] with orotracheal intubation were also significantly greater in the control group than in the esmolol group. More patients in the control than in the esmolol group moved after orotracheal intubation (23 vs 12, P<0.01).
Conclusion. Esmolol not only attenuated haemodynamic and somatic responses to laryngoscopy and orotracheal intubation, but also prevented BIS arousal reactions in patients anaesthetized with propofol.
Br J Anaesth 2002; 89: 857–62
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