Esmolol vs. nitroglycerin: attenuating hemodynamic response to laryngoscopy and intubation


  • Cassie Held Texas Christian University





Esmolol, Hemodynamic, Intubation, Laryngoscopy, Nitroglycerin.


Hemodynamic response to laryngoscopy and intubation is a common occurrence with the potential for harmful effects. Many drugs have been utilized throughout the years to attenuate this response with mixed results. This review compares the efficacy of two drugs, esmolol and nitroglycerin, in attenuating hemodynamic response to laryngoscopy and intubation. A systematic review was performed compiling all previous studies detailing the efficacy of esmolol in comparison to nitroglycerin for this purpose. Esmolol was found to consistently attenuate hemodynamic responses of blood pressure and heart rate with greater efficacy than nitroglycerin, and is thus recommended over nitroglycerin for use in this role.


[1] Aghdaii N, Ziyaeifard M, Faritus SZ, Azarfarin R (2015) Hemodynamic responses to two different anesthesia regimens in compromised left ventricular function patients undergoing coronary artery bypass graft surgery: etomidate-midazolam versus propofol-ketamine. Anesthesiology and Pain Medicine. 5, e27966.

[2] Gelman A, Stern H. (2006) The difference between "significant" and "not significant" is not itself statistically significant. The American Statistician. 60, 328-331.

[3] Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackl and DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 127, e6-e245.

[4] Gupta P, P anda B, Verma R, Ranjan P, Mathur S, Sinha G. (2009) Attenuation of haemodynamic responses to laryngoscopy & intubation following nitroglycerin and esmolol infusion. The Internet Journal of Anesthesiology. 22, e1-e5.

[5] Joanna Briggs Institute. New JBI levels of evidence. (2013) Available at: (accessed 18 October 2015).

[6] Kovac AL (1996) Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. Journal of Clinical Anesthesia. 8, 63-79.

[7] Reid LC, Brace DE (1940) Irritation of the respiratory tract and its reflex effect upon heart. Surgery, Gynaecology, Obstetrics. 70, 157-162.

[8] Sarkılar G, Sargın M, Sarıtas TB, Borazan H, Gök F, Kılıçaslan A, Otelcioğlu Ş (2015) Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery. International Journal of Clinical and Experimental Medicine. 8, 11477-11483. PMCID: PMC4565349.

[9] Singh H, Vichitvejpaisal P, Gaines GY, White PF. (1995) Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. Journal of Clinical Anesthesia. 7, 5-8.

[10] van den Berg AA, Savva D, Honjol NM. (1997) Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given i.v. with induction of anaesthesia. European Journal of Anaesthesiology. 14, 134-147. PMID: 9088811.

View Full Article: