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The role of ultrashort-acting beta-blockers in anaesthesia and intensive care


Authors: Rulíšek Jan;  Balík Martin;  Leden Pavel;  Zakharchenko Mikhailo
Authors‘ workplace: Klinika anesteziologie resuscitace a intenzivní medicíny, 1. LF UK a VFN v Praze
Published in: Anest. intenziv. Med., 25, 2014, č. 3, s. 203-211
Category: Anesthesiology - Review Article

Overview

Beta-1-adrenergic blocking agents are widely used in patients with ischaemic heart disease and patients with heart failure. Anaesthesiologists are in daily contact with these drugs as they are part of medication in anaesthetised patients undergoing surgical procedures. Long-term mortality benefit effect of these drugs has been proven. Esmolol as a representative of ultrashort-acting beta-blockers can be safely used to control septic tachycardia and promote myocardial protection in this situation. According to published data it can be used even if a patient has concomitant catecholamine infusion. In the peri-operative period, esmolol is indicated for short time haemodynamic suppression, for example in patients undergoing pheochromocytoma resection. In cardiac surgical patients, peri-operative infusion of esmolol led to better post-reperfusion myocardial adaptation. This article reviews the indications for esmolol with special attention to its use in septic patients.

Keywords:
Esmolol – septic tachycardia – septic shock – beta-1-blocking agent


Sources

1. Freemantle, N. et al. Beta blockade after myocardial infarction: systemic review and meta regression analysis. Br. Med. J., 1999, 318, p. 1730–1737.

2. Fonarow, G. C. et al. Effects of carvedilol early after myocardial infarction: analysis of the first 30 days in Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN). Am. Heart J., 2007, 154 (4), p. 637–644.

3. Deedwania, P. C. MERIT-HF Study Group. Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF. Am. Heart. J., 2005, 149 (1), p. 159–167.

4. Mangano, D. T. et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N. Engl. J. Med., 1996, 5, 335 (23), p. 1713–1720.

5. Rojas, Y. et al. Burns: an update on current pharmacotherapy. Expert Opin. Pharmacother., 2012, 13 (17), p. 2485–2494.

6. American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference. Definitions of sepsis and organ failure and Guidelines for the use of innovative therapies in sepsis. Crit. Care. Med., 1992, 20, p. 864–874.

7. Pitted, D. et al. Efficacy and safety of human activated protein C for severe sepsis. Am. J. Respir. Crit. Care, 1999, 160, p. 852–857.

8. Bernard, G. et al. Efficacy and safety of human rhAPC for severe sepsis. N. Engl. J. Med., 2001, 344, p. 749–762.

9. Warren, B. L. et al. Caring for the critically ill patient. High dose antithrombin III in severe sepsis: A randomised controlled trial. JAMA, 2001, 286, p. 1869–1878.

10. Vieillard-Baron, A. et al. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit. Care Med., 2008, 36 (6), p. 1701–1706.

11. Bouhemad, B. et al. Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit. Care Med., 2008, 36 (3), p. 766–774.

12. Kumar, A. et al. Tumor necrosis factor-alpha and interleukin 1-beta are responsible for in vitro myocardial cell depression induced by human septic shock serum. J. Exp. Med., 1996, 2, p. 949–958.

13. Tracey, K. J. et al. Shock and tissue injury induced by recombinant human cachectin. Science, 1986, 234, p. 470–474.

14. Finkel, M. S. et al. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science, 1992, 257, p. 387–389.

15. Murray, D. R. et al. Tumor necrosis factor-alpha induces a biphasic effect on myocardial contractility in conscious dogs. Circ. Res., 1995, 78, p. 154–160.

16. Okusawa, S. et al. Interleukin 1 induces a shock-like state in rabbits: Synergism with tumor necrosis factor and the effect of cyclooxygenase inhibition. 1988, 81, p. 162–172.

17. Schulz, R. et al. The role of nitric oxide in cardiac depression induced by interleukin-1 beta and tumor necrosis factor-alpha. Br. J. Pharmacol., 1995, 114, p. 27–34.

18. Opal, S. M. et al. Confirmatory interleukin 1 receptor antagonist trial in severe sepsis: A phase III randomised double blind , placebo-controled multicenter trial. Crit. Care Med., 1997, 25, p. 1115–1124.

19. Winslow, E. J. et al. Hemodynamic studies and results of therapy in 50 patients with bacteremic shock. Am. J. Med., 1973, 54, p. 421–432.

20. Krausz, M. M. et al. Cardiopulmonary effects of volumeloading in patients with septic shock. Am. Surg., 1977, 185, p. 429–434.

21. Parker, S. M. et al. Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit. Care Med., 1987, 15, p. 923–929.

22. Ahmed, A. J. et al. Hemodynamic responses to gram-positive versus gram-negative sepsis in critically ill patients with and without circulatory shock. Crit. Care Med., 1991, 19, p. 1520–1525.

23. Shoemaker, W. C. et al. Clinical trial of survivors cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit. Care Med., 1982, 10, p. 398–403.

24. Shoemaker, W. C., Appel, P. L., Kram, H. B. et al. Prospective trial of supranormal values of survivors as therapeutic goals in high risk surgical patients. Chest, 1988, 94, p. 1176–1186.

25. Rivers, E. et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N. Engl. J. Med., 2001, 345, p. 1368–1377.

26. Gattinoni, L. et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. N. Engl. J. Med., 1995, 333, p. 1025–1032.

27. Hayes, M. A. et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N. Engl. J. Med., 1994, 330, p. 1717–1722.

28. Dyson, A., Rudiger, A., Singer, M. et al. Temporal changes in tissue cardiorespiratory function during foecal perinotitis. Intensive Care Med., 2011, 37, p. 1192–200.

29. Levy, B., Bollaert, P. E. et al. Comparison of norepinephrine and dobutamine to epinphrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med., 1997, 23, p. 282–287.

30. Gore, D. C. et al. Lactic acidosis during sepsis is related to increased pyruvate production, not deficits in tissue oxygen availability. Ann. Surg., 1996, 224, p. 97–102.

31. Ronco, J. J. et al. Oxygen consumption is independent of increases in oxygen delivery by dobutamine in septic patients who have normal or increased plasma lactate. Am. Rev. Respir. Dis., 1993, 147, p. 25–31.

32. Tracey, K. J et al. Shock and tissue injury induced by recombinant human cachectin. Science, 1986, 234, p. 470–474.

33. Finkel, M. S. et al. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science, 1992, 257, p. 387–389.

34. Murray, D. R., Freeman, G. L. Tumor necrosis factor-alpha induces a biphasic effect on myocardial contractility in conscious dogs. Circ. Res., 1995, 78, p. 154–160.

35. Okusawa, S. et al. Interleukin 1 induces a shock-like state in rabbits: Synergism with tumor necrosis factor and the effect of cyclooxygenase inhibition. J. Clin. Invest., 1988 , 81, p. 1162–1172.

36. Schulz, R et al. The role of nitric oxide in cardiac depression induced by interleukin-1 beta and tumor necrosis factor-alpha.Br. J. Pharmacol., 1995, 114, p. 27–34.

37. Kumar, A., Thota, V., Dee, L. et al. Tumor necrosis factor-alpha and interleukin 1-beta are responsible for in vitro myocardial cell depression induced by human septic shock serum. J. Exp. Med., 1996, 2, p. 949–958.

38. Prabhu, S. D. et al. Beta-adrenergic blockade in developing heart failure: Effects on myocardial inflammatory cytokines, nitric oxide and remodeling. Circulation, 2000, 101, p. 2103–2109.

39. Kapadia, S., Lee, J., Amione, G. T. et al. Tumor necrosis factor alpha gene and protein expression in adult feline myocardium after endotoxin administration. J. Clin. Invest., 1995, 96, p. 1042–1052.

40. Prabhu, S. D. et al. Beta-adrenergic blockade in developing heart failure: Effects on myocardial inflammatory cytokines, nitric oxide and remodeling. Circulation, 2000, 101, p. 2103–2109.

41. Cunnion, R. E., Schaer, G. L., Parker, M. M. et al. The coronary circulation in human septic shock. Circulation, 1986, 73(4), p. 637–644.

42. Parker, M. M. et al. Profound but reversible myocardial depression in patients with septic shock. Ann. Intern. Med., 1984, 100, p. 483–490.

43. Poelaert, J. et al. Left ventricular systolic and diastolic function in septic shock. Intensive Care Med., 1997, 23, p. 553–560.

44. Munt, B. et al. Diastolic filling in human severe sepsis: an echocardiographic study. Crit. Care Med., 1998, 26, p. 1829–1833.

45. Suzuki, T. et al. Infusion of beta adrenergic blocker esmolol attenuates myocardial dysfunction in septic rats. Crit. Care. Med., 2005: 33: 2294–2301.

46. Aboab, J. et al. Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock. Intensive Care Med., 2011, 37(8), p. 1344–1351.

47. Balik, M., Rulisek, J., Leden, P. et al. Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Wien Klin. Wochenschr., 2012, 124 (15–16), p. 552–556.

48. Morelli, A. et al. Microvascular effects of heart rate control with esmolol in patients with septic shock: a pilot study. Crit. Care Med., 2013, 41 (9), p. 2162–2168.

49. Morelli, A. et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA, 2013, 310 (16), p. 1683–1691.

50. Rodríguez González, O. et al. Esmolol to control hemodynamic response during removal of a bilateral pheochromocytoma from a 10-year-old girl. Rev. Esp. Anestesiol. Reanim., 2010, 57 (7), p. 454–457.

51. Latendresse, T. R. et al. Anesthesia for pheochromocytoma resection in a child with Fontan circulation. Anaesth., 2011, 58 (7), p. 642–645.

52. Zakowski, M. et al. Esmolol use during resection of pheo-chromocytoma: report of three cases. Anesthesiology, 1989, 70(5), p. 875–877.

53. Shen, P. H. et al. Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial, Am. J. Rhinol. Allergy., 2011, 25 (6), p. 208–211.

54. Ibraheim, O. A. et al. Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes. Middle East J. Anesthesiol., 2013, 22 (1), p. 27–33.

55. Landoni, G., Crescenzi, G., Zangrillo, A. et al. Validation of a decision-making strategy for systolic anterior motion following mitral valve repair. Ann. Card. Anaesth., 2011, 14 (2), p. 85–90.

56. Landoni, G. et al. Esmolol reduces perioperative ischemia in noncardiac surgery: a meta-analysis of randomized controlled studies. J. Cardiothorac. Vasc. Anesth., 2010, 24 (2), p. 219–229.

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

58. Sun, J., Ding, Z., Qian, Y. Effect of short-acting beta blocker on the cardiac recovery after cardiopulmonary bypass.J. Cardiothorac. Surg., 2011, 6, p. 99.

59. Hilleman, D. E. et al. Esmolol versus diltiazem in atrial fibrillation following coronary artery bypass graft surgery. Curr. Med. Res. Opin., 2003, 19 (5), p. 376–382.

60. Guarracino, F. et al. β-Blockers to optimize peripheral oxygenation during extracorporeal membrane oxygenation: a case series. J. Cardiothorac. Vasc. Anesth., 2012, 26 (1), p. 58–63.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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