Esmolol 100mg/10ml solution for injection vials

IntroductionSeptic shock still entails significant morbidity and mortality, with the heart being affected due to catecholamine overexpression and direct injury from sepsis. Therefore, the effect of β-blocking the receptors to improve performance is promising when attempting to reverse tachycardia and reduce mortality.MethodsWe conducted a comprehensive search across five databases for studies published up to 28 January 2024, using a PICO strategy. Ten studies were identified for quantitative analysis and included in our meta-analysis.ResultsOur meta-analysis evaluated 28-day in-hospital mortality risk across nine randomized controlled trials (RCTs) involving a total of 1,121 adults with septic shock. We found an association between β-blocker use and reduced overall mortality (OR 0.57; 95% CI 0.34-0.98; I 2: 56%). This effect was significant in the esmolol subgroup (OR 0.47; 95% CI 0.26-0.82; I 2: 32%), but not in the landiolol subgroup (OR 0.98; 95% CI 0.0-1,284.5; I 2: 72%). Additionally, the intervention group shows a significant reduction in HR and lactate levels, as well as an increase in stroke volume index (SVI).ConclusionIn adults with septic shock, β-blockers are associated with a reduction in 28-day in-hospital mortality, a benefit primarily observed with esmolol rather than landiolol. Furthermore, improvements in heart rate (HR) control, lactate levels, and SVI were noted. However, these findings should be interpreted with caution, and further high-quality RCTs comparing different β-blockers are necessary to better elucidate these effects.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024513610.

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BackgroundEsmolol, an ultra-short-acting β1-selective adrenergic antagonist, has been investigated for its potential opioid-sparing effects in multimodal anesthesia. Previous systematic reviews included trials with different control groups causing severe limitations to the generalization of the findings. This systematic review and meta-analysis exclusively synthesized placebo-controlled randomized trials to evaluate the impact of intraoperative esmolol infusion on opioid consumption and postoperative pain scores within the first 24 hours after surgery.MethodsA systematic search was conducted in Medline, Embase, Cochrane Library, and Google Scholar to identify randomized placebo-controlled trials assessing the effects of continuous intraoperative esmolol infusion on opioid consumption and pain scores. The outcomes of interest were total intraoperative and postoperative opioid consumption, converted to intravenous morphine milligram equivalents (IV MME), and pain intensity, and assessed using either the visual analog scale (VAS) or the Numeric Rating Scale (NRS), both of which were standardized using validated methods to a common 0 to 10 scale. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed using Cochran's Q test and I² statistics. Meta-regression and subgroup analyses explored the effects of esmolol infusion rate, type of surgery, intraoperative anesthetic and hemodynamic management, and patient age as potential moderators.ResultsNineteen randomized trials (1028 patients) were included, involving esmolol regimens with a loading dose ranging from 0.5 to 1.0 mg/kg and a maintenance infusion rate of 0.3 to 6 mg/kg/h. Surgical procedures ranged from minimally invasive to open intracavitary surgeries. Esmolol infusion significantly reduced in 32% the intraoperative opioid consumption (mean differences [MD], -12.89 IV MME; 95% Confidence Interval, 95% confidence interval [CI], -24.74 to -1.05; P ConclusionsEsmolol infusion significantly reduces opioid consumption and postoperative pain, with a magnitude of effect that may have clinical significance. The observed effects remained consistent in subgroups where confounding variables, expected to bias the results toward the null, were present. However, the uncertainty in later pain outcomes and the persistent heterogeneity warrant further research into esmolol's applicability across different surgical contexts and populations.

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BackgroundTreatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.MethodsThe data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.ResultsA total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, - 0.10 [95% CI, - 0.22 to 0.02]; p = 0.11; p for Cochran's Q test = 0.001; I2 = 73%). No difference was seen when comparing patients aged ConclusionAdministration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.

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