ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Single dose esmolol attenuates bispectral index scale response to intubation during fentanyl-midazolam anesthesia for cardiac surgery
Hija Yazıcıoğlu1, Ayşegül Özgök1, Fatih Balaban2, Beyza Doğanay3, Süheyla Ünver4
1Department of Anesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara
2Department of Anesthesiology and Reanimation, Manisa Akhisar State Hospital, Manisa
3Department of Biostatistics, Medicine Faculty of Ankara University, Ankara
4Department of Anesthesiology and Reanimation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara
DOI : 10.5606/tgkdc.dergisi.2012.012
Background: In this study, we investigated whether esmolol prior to cardiac anesthesia induction can modify the bispectral index scale (BIS) response following orotracheal intubation.

Methods: After approval from the hospital ethics committee was obtained, we analyzed 64 ASA II patients who were scheduled for coronary artery bypass graft surgery. In the double-blind study, patients were divided into two subgroups before anesthesia induction with fentanyl-midazolam-rocuronium and randomized to esmolol (group E; n=32) or saline (group S; n=32). Following baseline measurements of vital signs and BIS score, patients received either 1 mg/kg esmolol intravenous or the equivalent volume of saline five minutes before anesthesia induction. Heart rate, mean arterial pressure and the BIS responses were recorded at baseline, at two minutes following infusion, at five minutes following induction, and at one, two and three minutes following intubation. The primary outcome of the study was Δ BIS. The study achieved a power of 95% for a-20%-change in Δ BIS.

Results: In the esmolol group, heart rate was decreased significantly compared to baseline in the second time point. Mean arterial pressure was similar between the groups at any time point. The BIS response was significantly higher in the saline group at one and two minutes following intubation, compared to esmolol group.

Conclusion: This study demonstrated that esmolol did not only decrease the heart rate within two minutes after injection but also attenuated BIS increases after the stimulation of orotracheal intubation. In addition, it seems that esmolol deepened the fentanyl-midazolam anesthesia.

Keywords : Bispectral index scale; cardiac anesthesia; esmolol; fentanyl; midazolam
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