[Characteristics and clinical use of esmolol]

Esmolol is a specific beta 1-blocker; it is hydrosoluble, without intrinsic sympathetic activity. Distribution half-life is 2 minutes and elimination half-life 9 minutes. Esmolol is hydrolyzed by the blood esterases. Its indications are all those where inotropism and heart rate must be briefly and specifically diminished using a titration technique: 1) In patients with coronary artery disease, or poor cerebral compliance, just before a strong nociceptive stimulus like intubation, extubation, skin incision, etc. 2) In patients with coronary artery disease, to decrease oxygen consumption by the myocardium. 3) In patients with hypertensive episodes per and post-operatively, especially in vascular surgery and neurosurgery. 4) In cardiac insufficiency due to obstructive cardiomyopathy. 5) In patients with specific cardiac rhythm problems. 6) In all patients where propranolol is indicated bu cannot de administered due to its long duration of action. Esmolol has to be given either as a mini-infusion at a rate of 300-600 micrograms/kg/min for the first 1-2 minutes followed by 200-300 micrograms/Kg/min or as a bolus (just before a nociceptive stimulus) 1-3 mg/kg. When using esmolol, it is important to set limits within which heart rate and blood pressure must remain. Over-dosage can occur easily but can be avoided without difficulty.