Esmolol 100mg/10ml solution for injection vials

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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ObjectivesThe clinical efficacy of short-acting β-blockers in the management of sepsis remains uncertain. In particular, the comparative effects of two commonly used agents-esmolol and landiolol-have not been clearly established. This network meta-analysis aims to systematically evaluate and compare the effects of esmolol, landiolol, and standard of care (SOC) on mortality in patients with sepsis.Data sourcesA systematic search of PubMed, Web of Science, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov , preprints, and citation searching was conducted before April 15, 2025.Study selectionRandomized controlled trials that enrolled adult patients (≥ 18 yr) diagnosed with sepsis or septic shock and treated with β-blockers and conducted in ICUs.Data extractionData were extracted on study characteristics, enrolled patients' characteristics, administration strategies of drugs, and key clinical outcomes (including 28-d mortality, ICU length of stay, and other relevant endpoints).Data synthesisA total of 1165 records were identified through searches of five databases, registries, and relevant references up to April 15, 2025. Ten studies involving 1035 patients were included, after screening and eligibility assessment. Compared with esmolol, landiolol was associated with increased 28-day mortality (relative risk [RR], 1.57; 95% CI, 1.08-2.30; low certainty) and higher norepinephrine requirements (mean difference [MD], 0.17 μg/kg/min; 95% CI, 0.02-0.32; low certainty). Esmolol significantly reduced 28-day mortality (RR, 0.69; 95% CI, 0.56-0.85; moderate certainty) and 24-hour heart rate (MD, -16.92 beats/min; 95% CI, -23.49 to -10.36; moderate certainty) compared with SOC. In contrast, landiolol increased norepinephrine use compared with SOC (MD, 0.09 μg/kg/min; 95% CI, 0.01-0.18; moderate certainty).ConclusionsAmong patients with sepsis treated with β-blockers, esmolol probably improves clinical outcomes compared with SOC. However, the effect of landiolol remains uncertain due to the low certainty of evidence. Esmolol may confer a relative clinical advantage over landiolol, but further studies are needed to confirm this finding and elucidate the underlying mechanisms.

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Abstract Background Functional Endoscopic Sinus Surgery (FESS) requires precise hemodynamic control to maintain a clear surgical field and minimize bleeding. Dexmedetomidine and esmolol are commonly used for this purpose, but their relative efficacy and safety has not been systematically evaluated. Objective To assess the relative efficacy and safety of dexmedetomidine and esmolol in patients undergoing FESS. Methods A systematic review and meta-analysis of randomized controlled trials was conducted. PubMed, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov and grey literature were searched to August 2025. Random-effects models were applied for pooled analyses in R software, version 4.5.1. Certainty of evidence was assessed using the GRADE approach. Results Eighteen trials (1056 participants, mean age 29.24 to 40.12 years, ASA I-II) were included. Both agents achieved comparable control of intraoperative blood loss (MD -1.18 mL, 95% CI: [-2.99 to 0.63], low-certainty). Esmolol resulted in faster emergence (MD 3.13 minutes shorter; 95% CI: [2.64 to 3.63], low-certainty), while dexmedetomidine prolonged time to first rescue analgesia (MD 27.83 minutes longer; 95% CI: [26.41 to 29.26], moderate-certainty) and time to modified Aldrete > 9 (MD 2.68 minutes longer; 95% CI: [2.26 to 3.11], low-certainty). Dexmedetomidine increased bradycardia risk (RR 3.96, 95% CI: [1.62 to 9.65], low-certainty) and dry mouth but reduced postoperative nausea and vomiting (RR 0.26, 95% CI: [0.10 to 0.73], low-certainty). Conclusion Moderate-to-low certainty evidence suggests both dexmedetomidine and esmolol may be effective for hemodynamic control during FESS. Esmolol may have quicker emergence and recovery, whereas dexmedetomidine may result in longer analgesia and less postoperative nausea, but increased bradycardia risk. Agent selection should consider patient needs and recovery priorities. Further high-quality trials are needed to strengthen the evidence base.

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BackgroundPersistent tachycardia in septic shock is associated with adverse outcomes, yet optimal management remains uncertain. Esmolol, a short-acting β1-selective blocker, has been investigated as a strategy to control heart rate and attenuate excessive sympathetic activation. This systematic review and meta-analysis evaluated the efficacy of esmolol in adult patients with septic shock.MethodsA comprehensive search of PubMed/MEDLINE, Cochrane Central, and Google Scholar was conducted from database inception to March 28, 2025. Reference lists and clinical trial registries were also screened. Randomized controlled trials comparing esmolol plus standard care with standard care alone in adults with septic shock were included. The primary outcome was 28-day mortality. Secondary outcomes included heart rate, mean arterial pressure (MAP), and lactate.ResultsThree randomized controlled trials involving 314 patients were included. Esmolol was associated with a significant reduction in 28-day mortality (OR 0.33, 95% CI 0.20-0.53; I2 = 0%). Heart rate was significantly reduced at both 24 h (day 1) (MD - 8.50 bpm, 95% CI - 10.82 to - 6.17) and 48 h (day 2) (MD - 16.60 bpm, 95% CI - 20.03 to - 13.17). No statistically significant difference in MAP was observed between groups (MD 0.10 mmHg, 95% CI - 3.46 to 3.66; I2 = 53%). Although the included studies did not report clinically meaningful differences in lactate levels, differences in outcome reporting precluded quantitative synthesis.ConclusionsEsmolol therapy may improve heart rate control and reduce 28-day mortality in carefully selected patients with septic shock without adversely affecting MAP. However, these findings should be interpreted cautiously because they are based on a limited number of randomized trials and are subject to clinical heterogeneity and potential risk of bias. Larger, high-quality randomized controlled trials are needed to confirm these findings and define the optimal use of esmolol in septic shock.Systematic review registrationThe review protocol was registered with PROSPERO (CRD42024584599).

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Landiolol is being investigated for its potential to manage septic shock (SS) and sepsis-related tachyarrhythmias (TA). We performed a systematic review and meta-analysis of three randomized controlled trials (RCTs) involving 473 patients with sepsis or SS, including those with TA, comparing landiolol to standard therapy-controlled (STC) groups. Standard therapy consisted of usual sepsis care ± placebo but excluded β-blockers in the control arms. MEDLINE, Embase, and Cochrane databases were searched for trial data extracted from published reports up to November 2024, excluding non-English reports. Quality assessment was performed per Cochrane recommendations. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled across trials to evaluate the outcomes. The primary endpoints included heart rate (HR) at 96 hours, chosen because all three trials consistently recorded HR at this time point, allowing for uniform comparison despite additional time points being reported, and 28-day mortality. Secondary outcomes included atrial fibrillation (AF), hypotension, changes in Sequential Organ Failure Assessment score, and norepinephrine dose. Of the three RCTs, 473 patients were included, with an intervention-to-control arm ratio of approximately 1:1. A lower HR (MD: -6.36; 95% CI: -9.25, -3.47; p < 0.0001; I² = 0%) was observed in the landiolol group compared to the STC. Hypotension (RR: 3.62, 95% CI: 1.37, 9.58; p = 0.010; I² = 5%) was significantly increased in patients who received landiolol when compared to STC, and 28-day mortality showed no significant difference between the groups (RR: 1.07; 95% CI: 0.72, 1.58; p = 0.74; I² = 44%), as did AF (RR: 0.63; 95% CI: 0.25, 1.59; p = 0.33; I² = 8%). Landiolol, a highly selective ultrashort-acting β1-blocker with distinct pharmacokinetic properties from esmolol, reduces HR in patients with sepsis-related TA without significantly affecting 28-day mortality. However, careful monitoring for hypotension is advised, given the absolute risk increase of 8.4% observed in treated patients. However, results should be interpreted cautiously as only three small trials underpin these results. To our knowledge, this is the first MA to focus exclusively on landiolol in this setting, offering drug-specific insights for critical care management.

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Background: Opioid-based anesthesia (OBA) has traditionally been the standard approach for intraoperative analgesia, but its use is associated with adverse effects such as respiratory depression, nausea and vomiting, hyperalgesia, and delayed recovery. To mitigate these issues, opioid-free anesthesia (OFA) regimens combining non-opioid agents (e.g., dexmedetomidine, ketamine, lidocaine, magnesium, esmolol) have been increasingly adopted. Although several randomized controlled trials (RCTs) have compared OFA with OBA in laparoscopic surgery, results remain heterogeneous. Methods: We performed a systematic review and meta-analysis of RCTs enrolling adult patients undergoing elective laparoscopic procedures, randomized to receive either OFA or OBA. Primary outcomes were postoperative pain intensity and incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included intraoperative and postoperative opioid consumption, hemodynamic stability, quality of recovery, and length of hospital stay. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and certainty of evidence was graded using GRADE methodology. Results: Sixteen RCTs, comprising over 1,300 patients undergoing laparoscopic cholecystectomy, gynecologic laparoscopy, bariatric surgery, colectomy, and urologic procedures, were included. Compared with OBA, OFA protocols consistently reduced postoperative opioid requirements and were associated with a lower incidence of PONV in several trials. Postoperative pain scores within 24 h were generally similar or modestly improved with OFA. Hemodynamic adverse events, including bradycardia and hypotension, occurred more frequently with dexmedetomidine-based regimens. Some studies reported slightly prolonged emergence or recovery times, but length of hospital stay was unaffected. Conclusions: OFA is a safe and feasible alternative to OBA in laparoscopic surgery and may offer advantages in reducing opioid consumption and PONV. However, considerable heterogeneity in drug protocols, study designs, and reported outcomes limits the ability to draw definitive conclusions. Large multicenter RCTs with standardized OFA strategies are needed to clarify its role in enhanced recovery pathways.

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