The hemodynamic effects of landiolol, an ultra-short-acting β1-selective blocker, on endotracheal intubation in patients with and without hypertension

BACKGROUND: The ultra-short-acting beta-selective blocker, landiolol, is widely used in Japan. We investigated the effects of landiolol on intubation-induced adrenergic response in 88 patients. METHODS: General anesthesia was induced and maintained with target-controlled infusion of propofol at an effect-site concentration of 5 mu g/mL. Muscle relaxation was obtained with 0.1 mg/kg vecuronium, and endotracheal intubation was performed 4 min after vecuronium injection. We first investigated the optimal time point for landiolol to be administered before intubation in 43 normotensive patients. Then we examined whether landiolol was as effective as fentanyl to prevent tachycardia after intubation in 45 hypertensive patients. RESULTS: Landiolol at 0.1 mg/kg was most effective against intubation-induced tachycardia when infused 4 min before intubation in normotensive patients. However, 0.2 mg/kg landiolol was necessary to prevent tachycardia after intubation in hypertensive patients. Landiolol had no significant effects on arterial blood pressure or bispectral. index at any dose throughout the study period. In contrast, 2 mu g/kg fentanyl frequently caused hypotension just before and 5 min after intubation. CONCLUSION: Low doses of landiolol can effectively prevent tachycardia after intubation without significant effects on arterial blood pressure.