Esmolol is the first intravenous, short-acting, titratable beta-blocker available for use in
critical care and surgical settings. The predominant pharmacodynamic actions of the
drug include a reduction in HR, BP, rate-pressure product, LVEF, and cardiac index. A desirable pharmacokinetic feature of
esmolol is its
esterase-induced rapid metabolic inactivation, which results in a return of all hemodynamic parameters to pretreatment levels within 30 minutes after discontinuation of the infusion. Control over the magnitude and duration of beta-blockade and the relative cardioselectivity of
esmolol make it an ideal agent for use in
critically ill patients, including those who, because of other conditions, are at risk if treated with beta-blockers. The clinical indications for
esmolol therapy include SVT and perioperative
tachycardia and
hypertension. In patients with myocardial ischemic conditions (acute
myocardial infarction and
unstable angina),
esmolol was safe and produced clinically significant reductions in HR and rate-pressure product. In general, untoward reactions to
esmolol have been minimal, mild, and transient. Although attention must be given to the possibility of systolic
hypotension during
esmolol administration, this complication often occurs at doses beyond those which provide optimal therapeutic response and may be avoided by titrating to the minimal effective dose. If systolic
hypotension occurs, it is reversible by either reducing the dose or discontinuing the
esmolol infusion. A nursing plan of care should be developed for patients receiving
esmolol therapy. Dosage and administration must be individualized. Careful titration of the
esmolol infusion and monitoring of therapeutic and safety parameters by nursing professionals will promote the achievement of maximum beta-blocker effect while avoiding persistent and unnecessary adverse reactions.