Use of Esmolol During Induction of General Anesthesia to Reduce Opioid Drug Usage - A Review of the Current Literature and Creation of an Educational Module for Anesthesia Providers
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Intubation is required for many surgical procedures, for which the standard is direct laryngoscopy. Direct laryngoscopy results in a sympathetic outflow which may be attenuated with multiple medications, such as esmolol or opioids. Due to the current culture and the inexpensive cost of the opioid fentanyl, providers are more likely to utilize it to minimize this response despite its negative side effects, such as nausea and vomiting. Esmolol is a superior alternative to opioids for prevention of the sympathetic response to direct laryngoscopy for several reasons. A review of the literature suggests esmolol is both a historic and more effective agent for preventing the sympathetic outflow caused by direct laryngoscopy. With the nationwide narcotic shortage, esmolol administration may be a simple solution to better utilize medicinal resources, avoid the negative side effects associated with fentanyl, and slow down consumption of the dwindling supply of narcotics. Education is a method of affecting change. A thirty-minute PowerPoint presentation was provided to 19 students of the graduating class of 2019 of the Nurse Anesthesia Program of AdventHealth University on September 27, 2018 to increase the knowledge base on the use of esmolol during induction of general anesthesia to reduce opioid drug usage. An identical ten question test was administered to 19 students of the graduating class of 2019 of the Nurse Anesthesia Program of AdventHealth University both before and after the PowerPoint presentation. The Statistical Package of Social Sciences program was used to analyze the results of the pre- and post-tests. The tests strategically contained multiple choice questions, to allow for quantitative interpretation. This method identified a clinically significant improvement in the knowledge base of esmolol use during induction of general anesthesia to reduce opioid drug usage.
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