The Efficacy of Esmolol to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

In this study, we aimed to determine the efficacy of esmolol infusion to prevent the hyperdynamic state which occurs during the recovery period and after extubation in the patients having lumbar disc surgery under general anesthesia. Forty five patients who would undergo elective lumbar disc surgery were randomly divided into three groups and general anesthesia was induced with 5-7 mg kg 1 sodiumthiopental and 0.5 mg kg 1 atracurium; it was maintained with isoflurane in 50/50 % oxygen-air mixture and 0.1-0.3 g kg 1 min 1 remifentanil infusion. On the completion of the surgery both of the goups (Group E1 and GroupE2) received esmolol 0.5 mg kg 1 as a loading dose. Following the 4 min infusion, Group E1 patients were administered 0.1 mg kg 1 min 1 esmolol while GroupE2 patients received 0.2 mg kg 1 min 1 esmolol infusion and it continued till 10 min after extubation. The control group (Group C) patients received the same dose of saline infusion for the same duration. Heart rate was significantly higher in control group than those in groups E1 and E2 at 5th and 10th min of esmolol infusion. Also mean arterial pressure was higher in the control group than those in groups E1 and E2 at 5th and 10th min during esmolol infusion and 10 min after extubation (p< 0.05). The time for opening eyes in response to verbal commands was shorter in both esmolol groups compared to the control group(p< 0.05). The time for opening eyes spontaneously in Group E2 was shorter than it was in the control group(p< 0.05) whereas there was no difference in Group E1. Five patients in the control group (33.3%) needed antihypertensive agents while there was no need for such additional agents in GroupE1 and GroupE2. We think that both dose profiles can be used to prevent hyperdynamic state which occur during extubation without extending the recovery period, which will lead to an early postoperative clinical assessment.