Effect of esmolol on fluid therapy in normovolemia and hypovolemia

Michael Kinsky, Sumreen U. Vaid, Luiz A. Vane, Donald Prough, George Kramer

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

β-Adrenergic agonists can enhance vascular volume expansion after a fluid bolus. The present study addresses how the β-adrenergic antagonist esmolol influences volume expansion and fluid balance during normovolemia (series 1) and hypovolemia (series 2). Sheep were instrumented, and the spleen was removed. For series 1, continuous infusion of 50 to 100 μg·kg -1·min -1 esmolol (n = 6) or control (no drug; n = 6) was begun 30 min before administration of a 24-mL kg -1 20-min bolus of 0.9% NaCl. For series 2, anesthetized sheep were infused with 50 to 100 μg·kg -1·min -1 esmolol (n = 6) or control (no drug; n = 6) 30 min before a·20 mL kg -1 hemorrhage. Fluid resuscitation (0.9% NaCl) was begun 30 min after hemorrhage. The 24·mL kg -1 20-min bolus was followed by titrated fluid therapy. Hemoglobin, fluid in, and urinary output were used to calculate changes in plasma volume (δPV), extravascular volume (δEVV = fluid in j urinary output - ΔPV), volume expansion efficiency (VEE = fluid in/ΔPV), and fluid distribution ratio (ΔPV/ΔEVV). Hemodynamics for both series were similar with the exception of heart rate. In series 1, peak ΔPV was 9.1 ± 1.0 mL kg -1 in control and 3.7 ± 1.0 mL kg -1 at study end. Esmolol resulted in a lower peak ΔPV (6.4 ± 2.0 mL kg -1) and a negative ΔPV (j0.4 ± 0.6 mL kg -1) at study's end. Urinary output was lower, and EVV was greater with esmolol. In series 2, esmolol increased fluid requirements (67 ± 7 mL kg -1) compared with control (54 ± 5 mL kg -1). Esmolol reduced ΔPV/ΔEVV. These data suggest that esmolol impairs the vascular retention of fluid and may increase the amount of volume support during fluid resuscitation.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalShock
Volume30
Issue number1
DOIs
StatePublished - Jul 2008

Fingerprint

Hypovolemia
Plasma Volume
Fluid Therapy
Drug and Narcotic Control
Resuscitation
Blood Vessels
Sheep
Hemorrhage
Adrenergic Agonists
Adrenergic Antagonists
Water-Electrolyte Balance
esmolol
Hemoglobins
Spleen
Heart Rate
Hemodynamics

Keywords

  • β-adrenergic antagonist
  • β-blocker
  • Anesthesia
  • Esmolol
  • Fluid therapy
  • Hemorrhage
  • Normovolemia
  • Pharmacologic modulation
  • Sheep

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine
  • Physiology

Cite this

Effect of esmolol on fluid therapy in normovolemia and hypovolemia. / Kinsky, Michael; Vaid, Sumreen U.; Vane, Luiz A.; Prough, Donald; Kramer, George.

In: Shock, Vol. 30, No. 1, 07.2008, p. 55-63.

Research output: Contribution to journalArticle

Kinsky, Michael ; Vaid, Sumreen U. ; Vane, Luiz A. ; Prough, Donald ; Kramer, George. / Effect of esmolol on fluid therapy in normovolemia and hypovolemia. In: Shock. 2008 ; Vol. 30, No. 1. pp. 55-63.
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