Esmolol

Question 1

What is the brand/trade name for esmolol?

Answer 1

• Brevibloc

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2}

Question 2

What is the pharmacologic category/class of esmolol?

Answer 2

Class

• Cardioselective beta-1 adrenergic antagonist
• Class II antiarrhythmic

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2
UpToDate - Esmolol: Drug Information}

Question 3

What is the mechanism of action of esmolol?

Answer 3

SA nodal cells: inhibits cAMP mediated sodium & calcium conductance during phase 4 of the action potential → ↓ chronotropy

Cardiac myocytes: inhibits cAMP mediated calcium conductance → ↓ inotropy

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2
UpToDate - Esmolol: Drug Information}

Question 4

What is the typical dosing of esmolol (bolus/loading and infusion)?

Answer 4

• bolus/load: 0.5-1 mg/kg
• infusion: 50-300 mcg/kg/min

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2
UpToDate - Esmolol: Drug Information}

Question 5

_______ mg of esmolol, administered about 2 minutes before direct laryngoscopy and intubation provides reliable protection against increases in HR and SBP

Answer 5

100-150

Other sources have a range of 25-100 mg

_{Master Anesthesia
Stoelting’s Pharmacology (5th), p. 483}

Question 6

What is the onset of action for esmolol?

Answer 6

• 1-2 minutes, with peak effect in 5 minutes

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2}

Question 7

What is the duration of action for esmolol?

Answer 7

• 10-20 minutes

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2}

Question 8

What organ(s) are responsible for esmolol’s clearance (metabolism/elimination)?

Answer 8

• Metabolism: plasma/RBC esterases
• Elimination: Kidneys

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2}

Question 9

What PMHx would you refrain from using esmolol as part of an opioid free induction?

Answer 9

Asthma