Emergency Drugs · Ultra-short-acting β₁ blocker (t½ ≈ 9 min)
Esmolol
Dose
Load 0.5 mg/kg over 1 min; infusion 50–200 mcg/kg/min (titrate every 4 min).
Mechanism
Rapidly hydrolysed by RBC esterases → titratable β₁ blockade.
Indications
- • Perioperative HTN/tachycardia
- • Aortic dissection HR control
- • Rate control AF/flutter
- • Refractory SVT
Contraindications
- • Severe bradycardia
- • Cardiogenic shock
- • Decompensated HF
Dilution & preparation
2.5 g in 250 mL D5W = 10 mg/mL
Administration
Central line preferred (peripheral only if brief).
Use
Titratable β-blockade in unstable haemodynamics.
Monitoring
Continuous ECG, arterial BP.
Side effects
- • Hypotension
- • Bradycardia
- • Infusion-site reaction
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
