We evaluated the clinical effectiveness of
esmolol, an ultra-short-acting beta 1-adrenergic receptor blocking
drug, to control the
sinus tachycardia and increase in arterial blood pressures induced by electroconvulsive therapy (ECT). Each of 20 patients, ASA physical status I-III, participated in a double-blind, randomized study, involving four match-pair trials (placebo versus
esmolol) during ECT. Each patient acted as his or her own control (total number of ECT procedures, 160). We administered a 4-min infusion of either placebo or
esmolol at the rate of 500 micrograms.kg-1.min-1. We then induced
anesthesia with
methohexital and
succinylcholine. After administration of electrical stimulation for ECT, the rate of infusion decreased to 300 micrograms.kg-1.min-1 for three additional minutes and was then discontinued. Statistically significant reductions in mean heart rate from minute 2 until minute 15 and in maximum heart rate (the mean of each patient's maximum heart rate after seizure changed from 152 +/- 23
to 115 +/- 24 beats/min) occurred in patients given
esmolol. During and immediately after infusion, arterial blood pressure also decreased. Finally, the length of
seizures decreased, as manifested clinically from 48 +/- 18 to 39 +/- 14 s and on electroencephalogram from 86 +/- 41 to 67 +/- 28 s. We conclude that
esmolol effectively controls the hyperdynamic response to ECT and reduces the length of
seizures. The significance of the latter to the overall effectiveness of ECT is not known.