Thirty-eight RCTs (n=2,009) were included.
SBP (28 RCTs): the average SBP after induction decreased by 13.8% with placebo, compared with 6.1% with esmolol; the average SBP after LTI increased by 26.3% (placebo) and 9.1% (esmolol), respectively.
DBP (14 RCTs): DBP after induction decreased by 3.4% with placebo, compared with 6.8% with esmolol; DBP after LTI increased by 34.2% (placebo) and 22.8% (esmolol), respectively. MAP (16 RCTs): MAP after induction decreased by 2.6% with placebo, compared with 10.1% with esmolol; MAP after LTI increased by 21.4% (placebo) and 10.6% (esmolol), respectively.
HR (36 RCTs): HR after induction increased by 7.2% from baseline with placebo, compared with a decrease of 4.2% from baseline with esmolol; HR after LTI increased by 29.6% (placebo) and 9.3% (esmolol), respectively. The change in HR was similar for patients with coronary artery disease or at an increased risk of cardiovascular disease (6 RCTs); the minimum values were +4.8% and -2% with placebo and esmolol, respectively, while the maximum values were +23% (placebo) and +6.7% (esmolol).
Opiates (19 RCTs): the results were presented for increases and decreases in the four outcome variables, with and without opiates, for esmolol and placebo.
There was no significant difference between esmolol and placebo when esmolol was given before or after the induction agents. No data were presented.
There was no significant difference between esmolol and placebo in the minimum decrease of SBP, MAP or HR after administration of the intervention, or in the maximum increase in SBP, MAP or HR after intubation. Only the DBP results between esmolol 200 mg and placebo differed: the baseline values of patients allocated to placebo were high (P=0.01). Data were presented.
Optimal results for HR control after LTI were obtained using a bolus of 500 microg/kg per minute over 4 minutes, followed by an infusion of 200 to 300 microg/kg per minute. Using this regimen, the decrease in HR with esmolol in comparison with placebo was 20.2 beats/minute (95% CI: 15.6, 24.7). The greatest reduction in blood-pressure before LTI was obtained using a 200 mg esmolol bolus: the decrease in SBP was 18 mmHg (95% CI: 14.4, 21.5), MAP 10.2 mmHg (95% CI: 3.1, 17.2), and DBP 10.1 mmHg (95% CI: 7.3, 12.8).
The 200-mg dose of esmolol significantly decreased all outcome variables in comparison with the 100-mg dose (P<0.01).