Email this article The effects of intravenous esmolol on hemodynamic response to endotracheal intubation and rocuronium onset time: A retrospective analysis
DOI: https://doi.org/10.20528/cjpm.2026.01.002
View Counter: Abstract | 187 times | ‒ Full Article | 80 times |
Full Text:
PDFAbstract
Background: Airway instrumentation during induction can elicit acute sympathetic stimulation with transient cardiovascular fluctuations, particularly elevations in arterial blood pressure. Esmolol, an ultra–short-acting β₁-selective antagonist, is often administered peri-induction to blunt these peri-intubation responses. However, its effects on neuromuscular blockade onset in routine clinical practice remain insufficiently explored. This retrospective study evaluated the association between peri-induction intravenous esmolol administration, hemodynamic responses to endotracheal intubation, and the onset time of rocuronium-induced neuromuscular blockade.
Methods: We retrospectively reviewed anesthesia charts of adult patients (18–60 years) with ASA physical status I–II who underwent elective surgery. Patients were classified according to peri-induction esmolol use: an esmolol group receiving a single intravenous bolus of 0.5 mg/kg (500 µg/kg) administered over 1 minute, and a control group without beta-blocker administration (30 patients per group). Anesthesia induction was performed with thiopental, fentanyl, and rocuronium (0.6 mg/kg). Neuromuscular blockade onset time was defined as the time from rocuronium administration to Train-of-Four count 1. Hemodynamic parameters were recorded before and after endotracheal intubation, and intubation conditions were assessed using the Cooper scale.
Results: Demographic characteristics were comparable between groups. The time to Train-of-Four count 1 was significantly longer in the esmolol group compared with controls (129.9 ± 22.8 s vs. 88.5 ± 12.0 s, p < 0.001). Between-group differences in systolic and diastolic arterial pressure were observed at specific early peri-intubation time points but were not sustained thereafter. Intubation conditions were significantly better in the esmolol group, with a higher proportion of patients achieving excellent Cooper scale scores (p < 0.05).
Conclusions: Peri-induction intravenous esmolol was associated with modulation of early hemodynamic responses to endotracheal intubation and a delayed onset of rocuronium-induced neuromuscular blockade. These findings suggest that esmolol may influence both cardiovascular responses and neuromuscular block onset during anesthesia induction. Future prospective investigations are needed to better delineate the clinical significance and mechanistic basis of this observed association.
Keywords
References
Takeuchi R, Hoshijima H, Tsukamoto M, Kokubu S, Mihara T, Shiga T. Hemodynamic response to tracheal intubation using indirect and direct laryngoscopes in pediatric patients: A systematic review and network meta-analysis. Children (Basel). 2025;12(6):786.
Sarkılar G, Sargın M, Sarıtaş TB, Borazan H, Gök F, Kılıçaslan A, Otelcioğlu Ş. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery. Int J Clin Exp Med. 2015;8(7):11477–11483.
Teong CY, Huang CC, Sun FJ. The haemodynamic response to endotracheal intubation at different time of fentanyl given during induction: A randomised controlled trial. Sci Rep. 2020;10(1):8829.
Tekir Yılmaz E, Kadıoğulları N, Menteş S. Comparison of the effects of fentanyl and dexmedetomidine administered İn different doses on hemodynamic responses during İntubation. Haydarpasa Numune Med J. 2022;62(4):417-423.
Zou Y, Kong G, Wei L, Ling Y, Tang Y, Zhang L, Huang Q. The effect of intravenous lidocaine on hemodynamic response to endotracheal intubation during sufentanil-based induction of anaesthesia. Anaesthesiol Intensive Ther. 2020;52(4):287–291.
Mendonça FT, Silva SL da, Nilton TM, Alves IRR. Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial. Braz J Anesthesiol. 2022;72(1):95–102.
Joshi D, Khandelwal A. To observe the effect of esmolol on the hemodynamic response to laryngoscopy and tracheal intubation. Indian J Crit Care Med. 2024;28(Suppl 1):S419–S420.
Sheeraz S, Farwa KU. Comparison of effect of Fentanyl versus Esmolol on attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. Med J South Punjab. 2025;6(3):6–12.
Deep G, Singh A, Kalia A, Gupta KK. Comparative evaluation of intravenous dexmedetomidine vs esmolol for attenuation of hemodynamic stress responseduring laryngoscopy and endotracheal intubation. Indian J Public Health Res Dev. 2024;15(3):220–6.
Esmolol compared with fentanyl in attenuating the hemodynamic response to tracheal intubation in hypertensive patients: A randomized controlled study. J Med Assoc Thai. 2022;105(8):667–673.
Lee JH, Kim Y, Lee KH, Rim SK, Lee JY, Lee C. The effects of nicardipine or esmolol on the onset time of rocuronium and intubation conditions during rapid sequence induction: a randomized double-blind trial. J Anesth. 2015;29(3):403–408.
Acharya R, Mishra SB, Rath A, Pati BS, Nayak KB. Effect of labetalol and esmolol on onset of action of rocuronium: A prospective double-blinded randomized controlled trial. Asian J Pharm Clin Res. 2018;11(6):133.
Ezri T, Szmuk P, Warters RD, Gebhard RE, Pivalizza EG, Katz J. Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol--the role of cardiac output. Acta Anaesthesiol Scand. 2003;47(9):1067–1072.
