Efficacy of landiolol in attenuating hemodynamic responses to local epinephrine infiltration in patients undergoing vaginal total hysterectomy

Abstract

Purpose

Local epinephrine infiltration often causes β₁-adrenoceptor-mediated tachycardia, hypertension, and arrhythmia. Landiolol, a short acting β₁-adrenoceptor blocker, may represent the most ideal agent to attenuate these adverse effects. In this study, we examined the effects of landiolol on the hemodynamic changes resulting from local infiltration of epinephrine.

Methods

Thirty-six patients undergoing vaginal total hysterectomy under general anesthesia were randomly assigned to one of three groups: control group (n = 12), L5 group (n = 12), and L10 group (n = 12). In the control, L5, and L10 groups, the patients were given saline, landiolol 5 mg, and 10 mg, respectively, just before infiltration of epinephrine(1 : 300 000; total dose, about 100 µg) into the surgical field. Blood pressure and heart rate was assessed before and 5, 10, 15, 20, 25, 30 min after the initiation of epinephrine infiltration. If systolic blood pressure and heart rate exceeded 160 mmHg and 120 beats·min⁻¹, respectively, Ca blockers of either diltiazem 5 mg or nicardipine 1 mg and/or 2% sevoflurane were given.

Results

Epinephrine infiltration significantly increased systolic blood pressure from 122 ± 15 to 170 ± 29 mmHg and heart rate from 63 ± 8 to 106 ± 10 beats·min⁻¹. In both the L5 and L10 groups, the increase in heart rate (from 69 ± 16 to 87 ± 16 beats·min⁻¹, P < 0.01, and from 70 ± 18 to 76 ± 9 beats·min⁻¹, P < 0.01, respectively) was significantly smaller compared to the control group, but the increase in systolic blood pressure was significantly attenuated in the L10 group (from 116 ± 18 to 140 ± 27 mmHg, P < 0.01). The number of patients given either Ca blockers or sevoflurane in the control group was significantly higher than that in the landiolol groups (P < 0.01).

Conclusion

The present study suggests that landiolol 10 mg may be a more suitable dose than landiolol 5 mg to antagonize hyperdynamic states induced by local administration of epinephrine.