Use of esmolol to attenuate hemodynamic responses during cataract extraction

Esmolol attenuates hemodynamic responses to tracheal intubation and extubation in young patients, but has less well documented pharmacokinetics and efficacy in older patients. Following cataract surgery, application of pressure on the eye during eye bandaging may have vasomotor effects. The present study of older patients having cataract surgery investigated 1) the effects of normal saline 1.0 ml. 10kg(-1) or esmolol 4.0 mg.kg(-1) IV given 90 secs prior to tracheal intubation and of normal saline 0.5 ml.10 kg(-1) or esmolol 2.0 mg.kg(-1) IV given 60 sec prior to each of eye bandaging and tracheal extubation; 2) the time to onset and duration of action of esmolol; 3) the cardiovascular effects of eye bandaging. Esmolol attenuated the cardiovascular effects of tracheal intubation, eye bandaging and tracheal extubation, but caused relative bradycardia and hypotension after induction and hypotension after extubation. Its effect occurred within 60-90 secs and lasted about 6 mins. Pressure on the eye during bandaging in those not given esmolol caused hypertension without tachycardia.