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AMBULATORY ANESTHESIA

The Effect of Intraoperative Use of Esmolol and Nicardipine on Recovery After Ambulatory Surgery

Paul F. White, PhD MD, FANZCA^*, Baoguo Wang, MD^*,, Jun Tang, MD^*,, Ronald H. Wender, MD, Robert Naruse, MD, and Alexander Sloninsky, MD

*Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California

Address correspondence and reprint requests to Dr. Paul F. White, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390–9068. Address e-mail to paul.white{at}utsouthwestern.edu

There is controversy regarding the optimal technique for maintaining hemodynamic stability during anesthesia. We designed this prospective, randomized, double-blinded study to test the hypothesis that the technique used for maintaining hemodynamic stability during general anesthesia can influence recovery after ambulatory surgery. Forty-five healthy consenting women undergoing gynecologic laparoscopy procedures were randomly assigned to 1 of 3 treatment groups: Group 1 (control, n = 15) received normal saline 5 mL and 1 mL, followed by a saline infusion at a rate of 0.005 mL · kg^-1 · min^-1; Group 2 (n = 15) received esmolol 50 mg and saline 1 mL, followed by an esmolol infusion 5 µg · kg^-1 · min^-1; and Group 3 (n = 15) received esmolol 50 mg and nicardipine 1 mg, followed by an esmolol infusion 5 µg · kg^-1 · min^-1. The study drugs were administered after the induction of anesthesia with fentanyl 1.5 µg/kg, and propofol 2 mg/kg IV. Tracheal intubation was facilitated with vecuronium 0.12 mg/kg IV. Anesthesia was initially maintained with desflurane 2% end-tidal and N₂O 67% in oxygen in all 3 groups. During surgery, the mean arterial blood pressure (MAP) was maintained within ±15% of the baseline value by varying the study drug infusion rate and the inspired concentration of desflurane. In addition to MAP and heart rate values, electroencephalogram bispectral index values were recorded throughout the perioperative period. Recovery times and postoperative side effects were assessed. Compared with the control group, adjunctive use of esmolol and nicardipine attenuated the increase in heart rate (in Group 2) and MAP (in Group 3) after tracheal intubation. Furthermore, the use of an esmolol infusion as an adjunct to desflurane to control the acute autonomic responses during the maintenance period significantly decreased emergence times (4 ± 2 versus 7 ± 4 min), decreased the need for postoperative opioid analgesics (43% versus 80%), and reduced the time to discharge (209 ± 89 versus 269 ± 100 min). We conclude that the adjunctive use of esmolol alone or in combination with nicardipine during the induction of anesthesia reduced the hemodynamic response to tracheal intubation. Furthermore, use of an esmolol infusion as an adjuvant to desflurane-N₂O anesthesia for controlling the acute hemodynamic responses during the maintenance period improved the recovery profile after outpatient laparoscopic surgery.

IMPLICATIONS: The adjunctive use of the ß-adrenergic blocker esmolol to control the acute sympathetic responses during desflurane-based anesthesia provided a more rapid awakening from anesthesia, reduced the postoperative opioid analgesic requirement, and decreased the time to discharge home after ambulatory laparoscopic surgery.

This article has been cited by other articles:

				T. Ozturk, H. Kaya, G. Aran, M. Aksun, and S. Savaci Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy Br. J. Anaesth., February 1, 2008; 100(2): 211 - 214. [Abstract] [Full Text] [PDF]

				V. Collard, G. Mistraletti, A. Taqi, J. F. Asenjo, L. S. Feldman, G. M. Fried, and F. Carli Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy Anesth. Analg., November 1, 2007; 105(5): 1255 - 1262. [Abstract] [Full Text] [PDF]

				P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]

				P. F. White Update on ambulatory anesthesia Can J Anesth, June 1, 2005; 52(suppl_1): R10 - R10. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999