Dupont critical care lecture: Role of ultrashort-acting β-blockers in the perioperative period

β-blockade can result in extreme bradycardia, significant conduction problems, bronchospasms, or left ventricular dysfunction. For this reason, the use of long-acting β-blockers is of limited value in the perioperative period. Esmolol, due to its ultrashort action and cardioselective properties, has been shown to be safe and effective for use in treatment of tachycardia and hypertension. Doses of up to 300 μg/kg/min for up to seven hours have been used with a return to baseline parameters within 30 minutes of discontinuation of the infusion. It can also be safely used in treatment of the asthmatic patient with tachycardia or hypertension with no clinically significant increases in airway resistance.^24,25 Studies using esmolol during general anesthesia have also demonstrated that it appears to have no significant interaction with various anesthetic agents.^8-10,12-14.