Esmolol Hydrochloride and Remifentanil Hydrochloride

• Generic Name: esmolol
• Dosage Forms: n.a.
• Other Brand Names: Brevibloc

Rapid, temporary control of ventricular rate in patients with supraventricular tachycardia (SVT) (e.g., atrial flutter and/or fibrillation, sinus tachycardia, junctional tachycardia, atrial tachycardia).

Vagal maneuvers and/or IV adenosine are considered first-line interventions for acute treatment of SVT when clinically indicated; if such measures are ineffective or not feasible, may consider an IV β-adrenergic blocking agent. Although evidence of efficacy is limited, experts state that overall safety of β-blockers warrants use.

May be used in patients with nonpreexcited atrial flutter and/or fibrillation to control rapid heart rate associated with surgical or other manipulative procedures (e.g., cardiac catheterization), or other emergent situations requiring short-term control of ventricular rate.

May be useful in patients with noncompensatory sinus tachycardia for short-term control of rapid heart rate requiring intervention.

Not intended for chronic use when other more appropriate antiarrhythmic agents would be preferred.

Treatment of intraoperative and postoperative hypertension and/or tachycardia. Has been used effectively for prevention or treatment of increases in BP associated with surgical events. However, use for prevention of such events is not recommended by the manufacturer.

Management of hypertensive emergencies in adults.

Rapid reduction of BP in the management of acute severe hypertension in pediatric patients with life-threatening symptoms.

Treatment to produce controlled hypotension during anesthesia in order to reduce bleeding resulting from surgical procedures (e.g., orthopedic surgery, neurosurgery).

Has been used for the management of acute tachyarrhythmias complicating acute MI and to minimize myocardial ischemia following acute MI or associated with unstable angina.

While current expert guidelines recommend an oral β-blocker in all patients with MI who do not have manifestations of heart failure, evidence of low-output state, increased risk of cardiogenic shock, or any other contraindications to β-blocker therapy, use of IV β-blockers should be limited to patients with refractory hypertension or ongoing ischemia.

• Generic Name: remifentanil
• Dosage Forms: n.a.
• Other Brand Names: Ultiva

As the analgesic component in the induction and maintenance of general anesthesia for inpatient and outpatient procedures. Although remifentanil has been used as the primary agent for induction of anesthesia, its use as the sole agent in general anesthesia is not recommended because loss of consciousness cannot be ensured and a high incidence of apnea, muscle rigidity, or tachycardia is possible.

May be continued in the immediate postoperative period in adults for whom later transition to longer-acting analgesics is desired; must be used under direct supervision of an anesthesia clinician in a postoperative anesthesia care unit or intensive care unit (ICU). Long-term (i.e., >16 hours) use of remifentanil in ICU patients has not been established to date.

May be particularly useful in surgical procedures requiring a rapid onset of analgesia and rapid recovery.

As the analgesic component of monitored anesthesia care (e.g., in conjunction with local or regional anesthesia for surgical procedures, including ophthalmic surgery, breast biopsy, and other superficial surgical procedures ) in adults.