S016: ESMOLOL IN MULTIMODAL THERAPY: OPTIMIZING HEMODYNAMIC STABILITY AND ANALGESIA IN SURGERY AND CRITICAL CARE
Kisha Cadet, BS; Adaku Onwuka, MS; Savreen Rangi, BS; Ravi Rajput, MD, MBA
American University of Antigua College of Medicine
Introduction: Maintaining hemodynamic stability and optimizing perioperative analgesia are key challenges in anesthesia and critical care. Esmolol, an ultra-short-acting β1-adrenergic receptor antagonist, has been increasingly used in combination with other pharmacological agents to enhance cardiovascular control, reduce anesthetic and analgesic requirements, and improve recovery outcomes. This systematic review synthesizes evidence from 17 randomized controlled trials (RCTs) involving 942 patients across various surgical and critical care settings to evaluate the benefits of Esmolol-based combination therapies in perioperative management.
Objectives: This study evaluates the effectiveness and safety of Esmolol-based combination therapies in improving hemodynamic stability, reducing anesthetic and analgesic consumption, and minimizing perioperative complications.
Methods: A systematic review and meta-analysis of RCTs was conducted. A systematic literature search was performed using PubMed, Cochrane Library, and Embase, applying strict inclusion criteria for studies on Esmolol combination therapies. Primary outcomes included hemodynamic parameters (mean arterial pressure, heart rate), opioid and analgesic consumption, recovery time, and adverse events. Statistical analysis used a random-effects model to assess pooled effect sizes, with heterogeneity evaluated using I² statistics.
Results: Esmolol-based combination therapies improved hemodynamic control compared to single-agent regimens, with a pooled effect size of 0.84 (95% CI: 0.59 to 1.08, p = 0.03) for mean arterial pressure reduction and 1.45 (95% CI: 1.00 to 1.90, p < 0.001) for heart rate stabilization. Patients receiving Esmolol combinations required less intraoperative anesthetic and analgesic medication, leading to faster recovery times and a 40% to 46.7% decrease in postoperative nausea and vomiting. Pain scores were lower in the Esmolol-treated groups (VAS reduction of 2.0-4.0 points), indicating improved analgesia. While mild bradycardia was reported, it was manageable with standard interventions.
Discussion/Conclusion: Esmolol-based combination therapies offer benefits in perioperative management by improving cardiovascular stability, reducing anesthetic and analgesic consumption, and enhancing recovery. These findings support using Esmolol in multimodal anesthetic strategies, particularly in procedures requiring controlled hypotension or reduced anesthetic use. While mild bradycardia remains a consideration, careful dose adjustment ensures a favorable safety profile. Future research should refine dosing strategies, explore Esmolol’s potential anti-inflammatory effects, and evaluate its role in broader critical care applications. Given its effectiveness and safety, Esmolol is a valuable option in modern perioperative and critical care management.