Esmolol: a unique Beta-blocker in maintaining cardiovascular stability following neurosurgical procedures

Patients with increased intracranial pressure (ICP) are prone to severe cardiac and or cerebral complications following emergence from general anesthesia and especially post-extubation phase. Administering beta blockers including esmolol is believed to be helpful in providing a stable hemodynamic at the end of the surgery and recovery stages and reducing recovery phase length.

In a double-blind prospective randomized clinical trial, 60 adult patients with ASA (American Society of Anesthesiologist) class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving esmolol (n=30) and placebo (n=30) as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation.

There was a significant difference between two groups regarding the changes of systolic blood pressure and heart rate at all studied stages after extubation (P≤0.05). However, no significant difference existed between esmolol and control groups regarding recovery and extubation times emphasizing the fact that esmolol is of excellent early recovery and extubation profiles.

Esmolol is advised to be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length.