• Masumi Miyazaki, Yuji Kadoi, and Shigeru Saito.
• Department of Anesthesia, Tomioka General Hospital, Tomioka, Japan.
• J Anesth. 2009 Jan 1;23(4):483-8.

PurposeTracheal extubation and emergence procedures induce abrupt changes in hemodynamics and humoral responses. We conducted a prospective randomized study to examine the effects of the short-acting beta-1 blocker, landiolol, on hemodynamics during emergence from anesthesia in elderly patients with and without hypertension.MethodsThirty-one hypertensive and 32 normotensive elderly patients were randomly divided into two groups: a control (placebo group) and a landiolol infusion group. Landiolol was dissolved in 20 ml of saline and administered as an infusion at the rate of 0.125 mg kg(-1) min(-1) for 1 min and then decreased to 0.04 mg kg(-1) min(-1) until extubation. Control patients received an equal volume of saline. Heart rate and blood pressure were recorded every minute from immediately before the administration of landiolol up to the discontinuation of landiolol, and every 5 min from the discontinuation of landiolol to 30 min after termination of the infusion.ResultsSystolic blood pressure in the control group patients with hypertension increased during anesthesia emergence and tracheal extubation, as did the heart rate. Landiolol infusion in the elderly patients with hypertension partially prevented the increase in systolic blood pressure and completely prevented the increase in heart rate associated with emergence from anesthesia. Landiolol infusion in the elderly patients without hypertension brought about a decrease in heart rate during emergence and tracheal extubation.ConclusionThis study indicates that the use of a landiolol infusion for preventing hemodynamic instability in elderly patients during the emergence period would be dependent on the presence or absence of hypertension in these patients.

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