Proposed Evidence-based Practice Guidelines for Using Esmolol to Blunt the Sympathetic Stress Response to Laryngoscopy and Intubation

Abstract

Direct laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review identified the efficacy and safety of administering a 1.5 mg/kg esmolol bolus three minutes before DL. The FSP will engage an interdisciplinary team to implement and evaluate the developed guidelines in a central Ohio hospital system. Baseline and intervention data on blood pressure, heart rate, and rate pressure product will be collected on 150 patients to assess the impact of an esmolol bolus on stress response attenuation during induction relative to traditional agents. Achieving a statistically significant improvement in hemodynamic stability will support esmolol’s adoption as a preferred induction agent. The FSP will provide clinical insights into optimizing anesthesia practices to enhance intraoperative patient safety and reduce opioid reliance. Should the desired outcomes be unmet, further research will be initiated to identify influencing factors and refine the esmolol induction guidelines accordingly