Bradycardia esmolol

Because of its brief half-life and minimal hpid solubihty, the side effects of esmolol are transient and include hypotension, cold extremities, dyspnea (from bronchospasms), bradycardia, nausea, vomiting, and headaches (41). 

Esmolol Hypotension, sinus bradycardia, AV block, heart failure exacerbation... 

The most serious side effects early in ACS are hypotension, bradycardia, and heart block. Initial acute administration of //-blockers is not appropriate for patients presenting with decompensated heart failure. However, therapy may be attempted in most patients before hospital discharge after treatment of acute heart failure. Diabetes mellitus is not a contraindication to //-blocker use. If possible intolerance to //-blockers is a concern (e.g., due to chronic obstructive pulmonary disease), a short-acting drug such as metoprolol or esmolol should be administered IV initially. 

Esmolol 3l > 2 Intravenous use half-life 10 min Rapid control of BP and arrhythmias, thyrotoxicosis and myocardial ischemia intraoperatively Parenteral only Toxicity Bradycardia hypotension... 

Class II (acebutolol, esmolol, propranolol. Bradycardia, heart block /i-adrenergic receptor blockade... 

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. 

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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