Blood Pressure, Heart Rate and Arrhythmia Control in the Perioperative Setting by the Short-Acting Beta Blocker Esmolol – A Review
Department of Anesthesiology and Surgical Intensive Care Medicine, 2Department of pediatrics, University Hospital
Halle (Saale), Martin-Luther-University, 3Department of plastic surgery, hand surgery and burn unit BG Klinikum
Bergmannstrost Halle, 4Department of Medicine III, 5Department of Medical Epidemiology Biostatistics and Informatics,
Martin-Luther-University, Halle (Saale), Germany.
Anna-Maria Burgdorff, Ann-Kristin Feudlinske, et al., “Blood Pressure, Heart Rate and Arrhythmia Control
in the Perioperative Setting by the Short-Acting Beta Blocker Esmolol – A Review”, American Research Journal of
Anesthesia, Vol 1, no. 1, 2022, pp. 8-26.
Abstract
Background: Patients who undergo surgery, especially with preexisting high cardiovascular risk and high-risk surgery,
are vulnerable for developing myocardial ischemia or tachyarrhythmias through sympathetic stimulation during
anesthesia. Aim of this systematic review is a summary of the evidence from all randomized controlled trials on the
efficacy and safety of the short acting β1-selective adrenoreceptor blocker esmolol in the prevention and treatment of
tachyarrhythmias and critical rises in blood pressure to avoid myocardial ischemia.
Methods and Findings: We examined the effect of esmolol in three different settings and included 5765 participants from
110 trials in our meta-analysis. We searched Medline, Embase, the Cochrane Library and hand-searched until January
2012 with an update through additionally search via PubMed to 2017 for articles published in English and German
language. Esmolol reduces blood pressure and heart rate significantly in comparison to placebo with better effects in
controlling heart rate than heart rhythm. In comparison to other active drugs there are no significant benefits for esmolol
in lowering blood pressure, heart rate or control of rhythm. Adverse effects of esmolol as hypotension, bradycardia
Conclusion: Esmolol shows reduction in myocardial ischemia in patients with cardiac disease, and with respect to adverse
effects and careful titration we recommend esmolol to prevent and treat crisis of blood pressure and heart rate. In healthy
patients the perioperative use of esmolol or other active drugs need to document its beneficial effect, further studies are
necessary.
