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Esmolol is an ultrashort-acting selective β1-antagonist. It primarily decreases heart rate with less of an effect on blood pressure. 
Treat/prevent perioperative tachycardia and hypertension .
Opioid sparing anesthesia.
While it is cardioselective at lower doses, use higher doses cautiously in patients with bronchospastic disease. 
Extreme caution should be used in patients with bradycardia, hypotension, greater than first degree heart block, cardiogenic shock or heart failure with reduced ejection fraction. Avoid in patients who recently received a calcium channel blocker. 
Mechanism of action
At normal doses it is a selective β1-antagonist, at higher doses it also inhibits β2 receptors in both bronchial and vascular smooth muscle. 
Onset of action
Beta-blockade with esmolol can be observed within 2-10 minutes of administration. Onset is typically quicker when administered as a bolus or with a loading dose prior to infusion.
Esmolol is metabolized by red blood cell esterases to inactive metabolites, which are renally excreted. 
Chemistry and formulation
- Morgan & Mikhail's clinical anesthesiology. John F., IV Butterworth, David C. Mackey, John D. Wasnick (Seventh edition ed.). New York. 2022. ISBN 9781260473797. OCLC 1309921315.
|edition=has extra text (help)CS1 maint: others (link)
- "UpToDate - Esmolol: Drug information". www.uptodate.com. Retrieved 2022-12-21.