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Letters to the Editor

Comparative Doses and Cost

Esmolol Versus Labetalol During Electroconvulsive Therapy

Drop, Lambertus MD, PhD; Castelli, Italo MD; Kaufmann, Mark MD

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doi: 10.1213/00000539-199804000-00051
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To the Editor:

Esmolol is a selective beta1-adrenergic blocking drug, whereas labetalol is a nonselective beta-adrenergic receptor blocker that also has alpha1-adrenergic receptor-selective blocking properties. Because of their short duration of onset, these drugs are useful clinically in the management of short-term hypertension and tachycardia, such as is often observed in association with electroconvulsive therapy (ECT). In 1995, we reported the comparative hemodynamic effects of esmolol and labetalol in patients presenting for ECT [1]. After IV administration immediately before ECT, equivalent decreases in peak systolic pressures were documented with esmolol (1.3 and 4.4 mg/kg) and labetalol (0.13 and 0.44 mg/kg). Thus, in adult patients, to attenuate the systolic blood pressure increases after ECT by 50%, 90 mg of esmolol was comparable to 9 mg of labetalol, and 300 mg and 30 mg of the respective drugs were required to nearly abolish the hypertensive response.

This equivalency is useful to determine the comparative cost of the two drugs. In all patients presenting for ECT, vital sign observations and clinical annotations are recorded and stored by computer at the bedside, allowing analysis of clinical data and determination of the total amount of labetalol administered. In the years 1994-1996, there were 3,172 ECTs, during which time a total of 21,330 mg of labetalol was used; the cost to the pharmacy was $3,440. Because the clinical effects of 10 mg of labetalol are comparable to those of 100 mg of esmolol [1], we would have used 21,3300 mg of esmolol, and the pharmacy cost would have been $17,064. In the time span of 3 yr, therefore, we saved $13,500.

Such a cost reduction may be substantial when applied to short-acting beta-adrenergic blocking drugs in other clinical settings. Important in the calculation of true savings is that labetalol may be obtained in multiple-dose vials, eliminating the expense of discarding vials that still contain unused drug. There were no adverse effects with either drug.

Lambertus Drop, MD, PhD

Department of Anesthesia and Critical Care; Massachusetts General Hospital; Boston, MA 02114

Italo Castelli, MD

Mark Kaufmann, MD

Kantonsspital; Basel, Switzerland


1. Castelli I, Steiner LA, Kaufmann MA, et al. Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy. Anesth Analg 1995;80:557-61.
© 1998 International Anesthesia Research Society