Esmolol compared with placebo in preventing increases in heart rate and blood pressure during rigid bronchoscopy

The effectiveness and safety of single-bolus dose esmolol was investigated in patients undergoing rigid bronchoscopy. Fortyfive ASA physical status I to III patients were randomly assigned to receive either placebo, esmolol, 100 mg, or esmolol, 200 mg, in a double-blinded fashion after the induction of anesthesia but prior to rigid bronchoscopy. Heart rate was not significantly greater than preoperative levels in both the esmolol 100- and 200-mg groups for up to 4.5 minutes after the start of rigid bronchoscopy and was significantly lower than placebo in both groups during the bronchoscopy. In contrast, heart rate was significantly increased above preoperative levels for up to 4.5 minutes during bronchoscopy in the placebo group. Systolic blood pressure was significantly lower than placebo at 1.5 minutes in the esmolol 100-mg group and at 1.5 to 2.5 minutes in the esmolol 200-mg group. However, systolic blood pressure was significantly elevated above preoperative values in all the groups during bronchoscopy. Similar results were observed for mean arterial pressure and diastolic blood pressure. No significant effects were noted on ST segment depression (serial 12-lead ECG) during bronchoscopy in any of the groups. A significantly greater number of patients had episodes of ventricular dysrhythmias in the placebo group (54%) compared with the esmolol 200-mg group (0%). No clinically significant episodes of bronchospasm were observed. Therefore, esmolol was found to be very effective in controlling hemodynamics during bronchoscopy.