Disease relevance of ESMOLOL

• Five patients required termination of infusion because of hypotension and all recovered uneventfully within 30 min of stopping the esmolol [1].
• The safety and efficacy of esmolol in lowering the ventricular rate and rate-pressure product in patients with acute myocardial infarction (n = 5), postmyocardial infarction angina (n = 10), or acute unstable angina (n = 4), and without cardiogenic shock were studied [1].
• Esmolol tilt testing with esmolol withdrawal for the evaluation of syncope in the young [2].
• Esmolol withdrawal testing has clinical utility before invasive testing as a first-line investigation for syncope in patients with or without heart disease [2].
• A new dosing regimen for esmolol to treat supraventricular tachyarrhythmia in Chinese patients [3].

Psychiatry related information on ESMOLOL

• Infusion of esmolol affects neither the blood oxygenation level-dependent contrast during the functional challenges nor the reaction times during the cognitive task [4].
• Defining the dose range for esmolol used in electroconvulsive therapy hemodynamic attenuation [5].
• In placebo-controlled clinical trials, the effects of infusion of esmolol on the sympathetically mediated hemodynamic responses to stressful events during the perioperative period were evaluated in patients scheduled for surgical procedures under general anesthesia [6].
• Another patient developed emesis and lethargy during esmolol therapy and required endotracheal intubation [7].

High impact information on ESMOLOL

• METHODS AND RESULTS: We created a model of global LV dysfunction by esmolol and phenylephrine infusion in six dogs. initially with LV expansion limited by increasing pericardial restraint and then with the pericardium opened [8].
• Thirty-two patients age 6 to 22 years with unexplained recurrent syncope or presyncope underwent tilt-testing involving two to four tilts (60 degrees) at baseline, during esmolol infusion (500 micrograms/kg load, 50 to 140 micrograms/kg per minute), after esmolol withdrawal, and during isoproterenol infusion if not contraindicated [9].
• Esmolol is a new ultra short-acting (half-life [t1/2] beta 9 min) beta 1-adrenergic-receptor antagonist reported to have no intrinsic sympathomimetic activity [1].
• BP slightly decreased during esmolol infusion, whereas heart rate, ionized calcium, phosphate, magnesium, and plasma and urine catecholamines remained unchanged [10].
• Esmolol increased mean plasma PTH by 33 +/- 8% (P < 0.01), due to a preferential increase in the pulsatile PTH secretion component (+129 +/- 44%, P < 0.02) [10].

Chemical compound and disease context of ESMOLOL

• RESULTS: Without esmolol, dobutamine stress induced myocardial ischemia with a reduction in regional wall thickening and lactate production in all nine pigs [11].
• To prolong viral incubation time, we induced a transient cardiac arrest (2 and 5 min) by a combination of acetylcholine and the beta-receptor antagonist, esmolol [12].
• Additionally, clinical studies have shown that titrated dosages of esmolol achieved therapeutic response rates of 66 to 79% in patients with supraventricular tachyarrhythmias, which favourably compared with response rates achieved with propranolol [13].
• Spinal cord perfusion pressure in dogs after control of proximal aortic hypertension during thoracic aortic cross-clamping with esmolol or sodium nitroprusside [14].
• After adenosine administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded) [15].

Biological context of ESMOLOL

• The initial infusion rate of esmolol was set at 150 or 100 micrograms/kg per min, depending on the patient's age and blood pressure [3].
• The purpose of this study was to find a safe dosing regimen for esmolol infusion to rapidly control supraventricular tachyarrhythmia after cardiac surgery in Chinese patients [3].
• The hemodynamic responses to esmolol, an ultrashort-acting (t1/2 = 9 min) beta 1-adrenergic receptor antagonist, were examined in 16 patients with myocardial ischemia and compromised left ventricular function as evidenced by a mean pulmonary capillary wedge pressure of 15 to 25 mm Hg [16].
• Rate-pressure product decreased by 33% and cardiac index by 14% during esmolol treatment, but pulmonary capillary wedge pressure was not significantly altered by drug infusion (19 +/- 3 mm Hg at baseline versus 19 +/- 5 during treatment, p = NS) [16].
• METHODS: In 10 anesthetized dogs, measurements of left ventricle (LV) peak (+)dP/dt and simultaneous endocardial action potentials were made during baseline conditions and after sequential administration of esmolol and sotalol [17].

Anatomical context of ESMOLOL

• The effect of esmolol (100 micrograms/kg per min) on the response of global cardiovascular and regional myocardial contractile function (sonomicrometry) to pacing-induced tachycardia and acute left ventricular afterloading was assessed in dogs with a critical stenosis of the left anterior descending coronary artery (LAD) [18].
• Change in activation after the administration of esmolol was also assessed and compared to the shift documented with successful sinus node (SN) modification [19].
• Data were acquired before and during esmolol infusion, thereby allowing assessment of hemodynamic responses with the sympathetic nervous system functionally intact as well as ablated [20].
• The elimination of esmolol is independent of renal or hepatic function as it is metabolised by red blood cell cytosol esterases to an acid metabolite and methanol [21].
• CONCLUSIONS: Esmolol infusion in sepsis improved oxygen utilization of myocardium and preserved myocardial function [22].

Associations of ESMOLOL with other chemical compounds

• During infusion of esmolol, four of nine patients receiving intravenous nitroglycerin required downward adjustment of nitroglycerin infusion rate to maintain systolic blood pressure greater than 90 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)[16]
• During ECT, intravenous nitroprusside and esmolol drips with arterial line monitoring were used to control the rise in blood pressure and heart rate [23].
• We then measure esmolol with a muBondapak C18 column and measure ultraviolet absorbance at 229 nm; the metabolite is analyzed with a Spherisorb phenyl column, with absorbance measured at 280 nm [24].
• Large and rapid fluctuations in cardiac output were generated by repeated dobutamine and esmolol challenge [25].
• An empirical index of relaxation, tau', and V(RVES) were manipulated by volume loading/caval constriction and isoproterenol/esmolol [26].

Gene context of ESMOLOL

• However, fractional shortening failed to detect changes in contractility during atrial pacing and esmolol infusion and its percent change was <20% [27].
• It is concluded that acute beta blockade with esmolol can be achieved in patients with COPD and cardiac disorders with little risk of bronchospasm [28].
• Data were obtained at baseline, at dobutamine and esmolol infusion to alter contractile state, and at inferior vena cava and aortic occlusion to alter preload and afterload [29].
• The blood esterase mediating the hydrolysis of esmolol was characterized in several different species including man [30].
• Use of esmolol in a parturient with hypertrophic obstructive cardiomyopathy [31].

Analytical, diagnostic and therapeutic context of ESMOLOL

• Esmolol, a new ultrashort-acting (9 minute half-life) beta-receptor blocking agent, was given by continuous intravenous infusion for up to 24 hours in 24 patients (21 with isolated coronary bypass surgery and 3 with valve replacement) 1 to 7 days after surgery [32].
• Coronary blood flow velocities (using a 0.014-in. [0.035 cm] Doppler guide wire) were measured at rest, during atrial pacing and during intravenous administration of a short-acting beta-blocker (esmolol, 50 to 500 micrograms/kg body weight per min) with continuous atrial pacing [33].
• Is esmolol cardioprotective? Tolerance of pacing tachycardia, acute afterloading and hemodilution in dogs with coronary stenosis [18].
• We sought to evaluate the effectiveness of esmolol vs placebo in 40 patients emerging from general anesthesia for neurosurgery [34].
• Multiple blood, urine, and dialysate samples were collected during a 72-hour period and assayed for esmolol and ASL-8123 by HPLC [35].

References