Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery

Background: Carbon dioxide (CO2) pneumoperitoneum for laparoscopic surgery increases arterial pressures, systemic vascular resistance and heart rate and decreases urine output. Methods: In this double-blind randomized study esmolol, an ultrashort-acting beta 1-adrenoceptor antagonist was compared with physiological saline (control) in 28 patients undergoing laparoscopic surgery in standardized 1 MAC isoflurane anaesthesia. Alfentanil infusion was used to prevent the increase of mean arterial pressure more than 25% from baseline. Results: Esmolol effectively prevented the presser response to induction and maintenance of CO2 pneumoperitoneum. Significantly (P<0.001) less alfentanil was needed in the esmolol group than in the control group. Urine output was higher (P<0.05) and plasma renin activity (P<0.01) and urine N-acetyl-beta-D-glucosaminidase levels lower in the esmolol group when compared with the control group. Conclusions: Esmolol blunts the presser response to induction and maintenance of pneumoperitoneum and may protect against renal ischaemia during pneumoperitoneum.