• Antonios A Louizos, Sophie J Hadzilia, Dimitrios I Davilis, Evangelia G Samanta, and Loucas G Georgiou.
• Department of Anesthesiology, Hippocration General Hospital, Athens, Greece.
• Ann Oto Rhinol Laryn. 2007 Feb 1;116(2):107-11.

ObjectivesCigarette smokers constitute a group of patients with an increased hemodynamic response to tracheal intubation. We studied the dose-response and side effects of bolus administration of esmolol hydrochloride in cigarette smokers undergoing elective microlaryngeal surgery, when esmolol was used for reducing the intense hemodynamic response to laryngoscopy and tracheal intubation.MethodsWe randomly allocated 165 patients (American Society of Anesthesiologists physical status classes I to III) to receive placebo (Eplac) or esmolol 1 mg/kg (E1) or 2 mg/kg (E2). The esmolol was given 2 minutes before laryngoscopy and tracheal intubation. The same anesthetic technique was used in all patients. Cardiovascular parameters were recorded every minute for the first 5 minutes and thereafter every 3 minutes. Bronchospasm, other side effects, and rescue esmolol treatment were noted during anesthesia.ResultsIn group Eplac, significant increases (p < .05) in arterial blood pressure and heart rate were observed in the first 3 minutes after tracheal intubation. In group E1, significant increases (p < .05) in diastolic blood pressure were observed in the first 2 minutes after intubation. In group E2, no significant fluctuations were recorded in cardiovascular parameters after intubation. During surgery, 17% of the patients in group Eplac showed an increase in blood pressure and tachycardia.ConclusionsWe conclude that esmolol administration of 2 mg/kg during induction of anesthesia in smokers provides hemodynamic stability after laryngoscopy and tracheal intubation with no severe side effects.

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