Bolus Administration of Esmolol Attenuates Hemodynamic Effects in Adults Undergoing Laryngoscopy and Endotracheal Intubation: Meta-Analysis of Randomized Controlled Trials

Endotracheal intubation by direct laryngoscopy often elicits a reflex response from the sympathetic nervous system that triggers tachycardia and hypertension. Studies that address the use of esmolol in this context show great heterogeneity, making difficult its applicability in clinical practice. Thus, we evaluated the effect of bolus administration of esmolol on heart rate and blood pressure in adult patients undergoing general anesthesia in elective surgeries. Meta-analysis of randomized, double-blind clinical trials with adults undergoing laryngoscopy/endotracheal intubation for elective procedures under general anesthesia using esmolol or saline. English-language articles in PubMed and ClinicalKey databases with terms such as esmolol, laryngoscopy, endotracheal intubation, hypertension, and tachycardia were included. Duplicate articles, which used esmolol in continuous infusion, without a control group, without results in mean and standard deviation formats were excluded. A random effects model was adopted with DerSimonian-Laird tests and weighted mean difference (WMD) calculation for continuous variables, with their respective 95% confidence intervals (95%CI). Of the 287 studies identified, 13 were selected, accounting for 893 patients (447 in the esmolol group and 446 controls). The use of esmolol was considered a protective factor in decreasing heart rate (DMP = -15.66; 95% CI -18.06 to -13.27 and p < 0.001) and mean arterial pressure (DMP = -12.12; 95% CI -18.32 to -5.92 and p < 0.001) during laryngoscopy and endotracheal intubation. Esmolol reduces the sympathetic autonomic response of adults undergoing laryngoscopy and endotracheal intubation.