Transplacental passage and hemodynamic effects of esmolol in the gravid ewe

Using a chronic maternal-fetal sheep preparation, the authors determined the transplacental passage and the hemodynamic changes consequent to maternal administration of esmolol. Fifteen experiments were performed in six chronically instrumented pregnant ewes near term. Each animal received esmolol iv, 500 micrograms.kg-1.min-1, for 4 min and then 300 micrograms.kg-1.min-1 for 6 min. Maternal and fetal blood esmolol concentrations (mean +/- SEM) were 1.2 +/- 0.28 and 0.1 +/- 0.03 micrograms/ml, respectively, at the completion of the infusion, and 0.03 +/- 0.01 microgram/ml in the mother and not detectable in the fetus 10 min after stopping the infusion. Despite the relatively low blood esmolol concentration in the fetus compared to the mother, the hemodynamic effects in the fetus were similar to those in the mother. The maximal decrease of maternal mean arterial pressure (MAP) and heart rate (HR) were 7 +/- 2 and 14 +/- 3% (mean +/- SEM), respectively (P less than .05). The maximal decrease of fetal MAP and HR were 7 +/- 2 and 12 +/- 3%, respectively (P less than .05). No changes were seen in maternal or fetal acid-base variables, and intra-amniotic pressure was not affected. The authors conclude that esmolol has a rapid but relatively small transplacental passage, and it is eliminated rapidly from both maternal and fetal plasma.