Intubation and extubation lead to an increase in heart rate and blood pressure as well as rising peri- and postoperative complications for cardiac prestressed and healthy cardiac patients. The present systematic review examined the effectiveness of Esmolol to reduce the increase in heart rate and heart pressure under intubation and extubation. Therefore, 49 randomized controlled trials involving 3386 patients in the comparison of Esmolol versus a placebo or another active drug were included. Primary outcome was the maximum change of systolic- or mean arterial blood pressure, while heart rate, diastolic- and mean arterial blood pressure, the rate-pressure-product and encountered side effects were the secondary outcomes. Compared to placebo, Esmolol showed a significant advantage. This advantage could not be observed in all groups using other effective drugs. These results show how Esmolol effectively reduces heart rate and blood pressure, while decreasing the risk of cardiac ischemia.