Esmolol adverse effects

The most frequently reported adverse effects are hypotension, nausea, dizziness, headache, and dyspnea. As with many (3-blocktng drugs, esmolol is contraindicated in patients with overt heart failure and those in cardiogenic shock. 

Esmolol (Brevibloc, others) is a Pi-selective antagonist with a very short duration of action. It has little if any intrinsic sympathomimetic activity, and it lacks membrane-stabilizing actions. Esmolol is administered intravenonsly and is nsed when P-blockade of short dnration is desired, or in critically ill patients in whom adverse effects of bradycardia, heart failure, or hypotension may necessitate rapid withdrawal of the drug. 

I. Pharmacology. Esmolol is a short-acting, IV, cardioselective beta-adrenergic blocker with no intrinsic sympathomimetic or membrane-depressant activity. In usual therapeutic doses, it causes little or no bronohospasm in patients with asthma. Esmolol produces peak effects within 6-10 minutes of administration of an intravenous bolus. It is rapidly hydrolyzed by red blood cell esterases, with an elimination half-life of 9 minutes therapeutic and adverse effects disappear within 30 minutes after the infusion is discontinued. 

However, in one study 60 patients were given one of three treatments before induction of anaesthesia with propofol esmolol 1 mg/kg followed by an infusion of250 micrograms/kg per minute midazolam or placebo (sodium chloride 0.9%). No opioids were given. Esmolol and midazolam reduced the required induction doses of propofol by 25% and 45%, respectively. Esmolol reduced the mean heart rate by 7.6 bpm compared with placebo in the pre-induction period, and the only adverse effect noted was a transient episode of bradycardia (44 bpm) in one patient receiving esmolol. Esmolol reduces cardiac output by reduction of heart rate and stroke volume and this possibly reduces the required induction dose of propofol by changing its distribution."... 

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