Pharmacology

Esmolol

Esmolol (Brevibloc) is a short acting, beta-1 selective blocker metabolized by non-specific red blood cell (RBC) plasma esterases via hydrolysis. Therefore, esmolol’s elimination half-life is short (< 10 minutes) and fairly independent of coexisting organ dysfunction.

It’s a very popular drug in the perioperative world BECAUSE of its short-acting, titrable nature. I’ve “tested” responses to beta-blockers with esmolol before using longer acting beta-1 selective agents like metoprolol in patients with dysrhythmias like atrial fibrillation or flutter. I also use 0.5 – 1 mg/kg to blunt the hemodynamic lability associated with laryngoscope, Mayfield skull pinning, etc.

Most commonly, I see patients on esmolol drips who are admitted with ascending aorta dissections. Yes, controlling the blood pressure is important, but heart rate control is critical to minimize shear forces along the compromised aortic wall which could extend the dissection.

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Rishi

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