The safety and effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery

Objectives: To determine (1) if perioperative use of esmolol in major vascu lar surgery patients provides strict heart rate (HR) control, (2) what dose s of esmolol are required to do this, and (3) does this control influence m yocardial ischemia or result in adverse consequences. Design: Prospective study of 40 patients randomized to two groups: The HR w as controlled to either less than 80 beats/min (group 80) or less than 110 beats/min (group 110) using esmolol, Patients were monitored continuously f or electrocardiographic changes perioperatively. HR control began after ind uction of anesthesia and continued for 48 hours thereafter, Setting: Operating room and intensive care unit. Patients: Patients undergoing abdominal vascular surgery involving aortic c ross-clamping. Interventions: Esmolol was titrated until the target HR was met. Measurements and Results: Only one patient demonstrated an adverse effect. The median infusion rates were 100 and 12.5 mu g/kg/min for groups 80 and 1 10. Target HR was met less in group 80 than in group 110, primarily in the postoperative period. Ischemia patterns were not significantly different be tween groups. Conclusion: Using esmolol for HR control in the intraoperative period for a bdominal vascular surgery patients is effective and safe. HR control was mu ch less effective in the postoperative period, but esmolol is safe when use d at recommended doses, Further study with a larger number of patients is n ecessary to determine whether strict HR control with esmolol affects the in cidence of myocardial ischemia or infarction in this patient population. Co pyright (C) 1999 by W.B. Saunders Company.