1 / 46

PREINDUCTION INTRAVENOUS LABETALOL FOR ATTENUATING INTUBATION STRESS RESPONSE

PREINDUCTION INTRAVENOUS LABETALOL FOR ATTENUATING INTUBATION STRESS RESPONSE. DR. A. KARTHIK KILPAUK MEDICAL COLLEGE. GUIDE : PROF. DR. P.S.SHANMUGAM, MD, DA HEAD OF DEPARTMENT DEPARTMENT OF ANAESTHESIOLOGY, KILPAUK MEDICAL COLLEGE.

jarvis
Download Presentation

PREINDUCTION INTRAVENOUS LABETALOL FOR ATTENUATING INTUBATION STRESS RESPONSE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PREINDUCTION INTRAVENOUS LABETALOL FOR ATTENUATING INTUBATION STRESS RESPONSE DR. A. KARTHIK KILPAUK MEDICAL COLLEGE

  2. GUIDE : PROF. DR. P.S.SHANMUGAM, MD, DA HEAD OF DEPARTMENT DEPARTMENT OF ANAESTHESIOLOGY, KILPAUK MEDICAL COLLEGE. ETHICAL COMMITTEE APPROVAL OBTAINED

  3. AIM OF THE STUDY To study and compare the effects of Preinduction intravenous Labetalol at incremental doses of 0.25mg/kg & 0.5mg/kg in attenuation of intubation stress response in General Anaesthesia

  4. STUDY DESIGN Randomized, Prospective study Pre study assessment done and consent obtained from all the patients

  5. PATIENT SELECTION INCLUSION CRITERIA : 45 patients of ASA grade I & II Age 18 – 60 yrs Both sex Elective surgery requiring general anaesthesia with endotracheal intubation

  6. EXCLUSION CRITERIA : Patient contraindicated to -blocker; eg- Bronchial Asthma, Peripheral vascular disease, conduction defects Hypertensive patients, patients on Anti-HT drugs Systolic BP < 90mmHg; HR< 50/mt Having preoperative airway or intubation problems Awake intubation or intubation taking more than 20sec or requiring second attempt are excluded

  7. GROUPS GROUP A : 15 patients receiving IV Normal saline (Placebo) prior to induction (Control) GROUP B : 15 patients receiving Inj. Labetalol 0.25mg/kg prior to induction GROUP C : 15 patients receiving Inj. Labetalol 0.5 mg/kg prior to induction

  8. MONITORING Pulse oximetry NIBP ECG

  9. METHODOLOGY 45 patients randomized into three groups of 15 each Premedication: Given i.m 45 min prior to surgery Inj. Glycopyrrolate 10ug/kg Inj. Pentazocine 0.5mg /kg Preoxygenation : 100% O2 for 5 min InjLabetalol/ Normal saline given iv 5 min prior to induction Induction : Inj.Propofol 2mg/kg iv

  10. NDMR – InjRocuronium 0.9mg/Kg iv Patient ventilated with 100% O2 for 3 min Intubated with appropriate size ET tube Maintained with O2 : N2O – 1:2 Volatile inhalational agents used only 10min after intubation

  11. Pulse rate & NIBP were recorded: • Preoperatively • 45 min after premedication • In the operating table before IV Labetalol/Normal saline • For every min after IV Labetalol/Normal saline for 5 min • After Induction • After giving NDMR • At laryngoscopy • For every 1 min after Endotracheal intubation for 10min

  12. Labetalol — Mechanism • Competitive, selective 1and non-selective -blocker •  >  blocking potency oral is 3:1, iv is 7:1 • It has intrinisic partial B2 agonistic activity hence causes vasodilation • Onset: 5-10 min • Duration of action: 3-6hrs • T1/2 – 5-8hrs

  13. CVS Effects Decrease SVR leading to decrease in BP is by alpha -1 blockade Vasodilation also produced by partial B2 agonist activity Reflex tachycardia due to peripheral vasodilation is attenuated by B blockade Cardiac output remains unchanged Presynaptic alpha-2 receptors are spared- hence release of Norepinephrine is intact, which inhibits further release of catecholamine (Neg feedback mech)

  14. Adverse effects Orthostatic hypotension Bronchospasm Others- CCF, bradycardia, Heart block Increased plasma aminotransferase Paresthesia – scalp tingling Urinary retention

  15. STATISTICAL ANALYSIS

  16. STATISTICAL TEST USED ANOVA test F test If significance is there, then subjected to Post Hoc Test

  17. ANALYSIS OF AGE AMONG THE GROUPS P value = 0.834, which is not significant

  18. COMPARISON OF PREOP HEART RATE AMONG THE GROUPS P=0.911 , NOT SIGNIFICANT

  19. COMPARISON OF PREOP SYSTOLIC BP AMONG THE GROUPS P=0.567 , NOT SIGNIFICANT

  20. COMPARISON OF PREOP DIASTOLIC BP AMONG THE GROUPS P=0.420 , NOT SIGNIFICANT

  21. COMPARISON OF HR AFTER 5MIN OF LABETALOL IV P=0.368 , NOT SIGNIFICANT

  22. COMPARISON OF SYSTOLIC BP AFTER 5MIN OF LABETALOL IV P=0.985 , NOT SIGNIFICANT

  23. COMPARISON OF DIASTOLIC BP AFTER 5MIN OF LABETALOL IV P=0.105, NOT SIGNIFICANT

  24. COMPARISON OF HEART RATE AT LARYNGOSCOPY P=0.000 , SIGNIFICANT By Post Hoc Test: There was a difference between the control & Labetalol groups, but there was no significant difference between the two Labetalol groups (P=0.815)

  25. COMPARISON OF HEART RATE AT 1 MIN AFTER INTUBATION P=0.001, SIGNIFICANT By Post Hoc Test: There was a difference between the control & Labetalol groups, but there was no significant difference between the two Labetalol groups (P=0.851)

  26. COMPARISON OF HEART RATE AT 3 MIN AFTER INTUBATION P=0.007, SIGNIFICANT By Post Hoc Test: There was a difference between the control & Labetalol groups, but there was no significant difference between the two Labetalol groups (P=0.989)

  27. COMPARISON OF HEART RATE AT 5 MIN AFTER INTUBATION P=0.02, SIGNIFICANT By Post Hoc Test: There was a difference between the control & Labetalol groups, but there was no significant difference between the two Labetalol groups (P=0.827)

  28. COMPARISON OF HEART RATE AT 10 MIN AFTER INTUBATION P=0.022, SIGNIFICANT By Post Hoc Test: There was a difference between the control & Labetalol groups, but there was no significant difference between the two Labetalol groups (P=0.805)

  29. COMPARISON OF SYSTOLIC BP AT LARYNGOSCOPY P=0.189 , NOT SIGNIFICANT

  30. COMPARISON OF SYSTOLIC BP AT 1 MIN AFTER INTUBATION P=0.212, NOT SIGNIFICANT

  31. COMPARISON OF SYSTOLIC BP AT 3 MIN AFTER INTUBATION P=0.200, NOT SIGNIFICANT

  32. COMPARISON OF SYSTOLIC BP AT 5 MIN AFTER INTUBATION P=0.021, SIGNIFICANT

  33. COMPARISON OF SYSTOLIC BP AT 10 MIN AFTER INTUBATION P=0.051, NOT SIGNIFICANT

  34. COMPARISON OF DIASTOLIC BP AT LARYNGOSCOPY P=0.039 , SIGNIFICANT

  35. COMPARISON OF DIASTOLIC BP AT 1 MIN AFTER INTUBATION P=0.023, SIGNIFICANT

  36. COMPARISON OF DIASTOLIC BP AT 3 MIN AFTER INTUBATION P=0.063, NOT SIGNIFICANT

  37. COMPARISON OF DIASTOLIC BP AT 5 MIN AFTER INTUBATION P=0.028, SIGNIFICANT

  38. COMPARISON OF DIASTOLIC BP AT 10 MIN AFTER INTUBATION P=0.021, SIGNIFICANT

  39. CONCLUSION • Heart Rate: • Preinduction iv labetalol decreased the heart rate prior to induction in the Labetalol groups (decrease in Group C>Group B>Group A) at 5 min after labetalol injection. But it is not statistically significant • Attenuation of heart rate at Laryngoscopy, at 1min, 3min, 5min, 7min & 10min after intubation (decrease in Group C>Group B>Group A) is statistically significant. • Preop HR was achieved at 1 min after intubation

  40. HEART RATE

  41. CONCLUSION • Systolic BP: • Preinduction iv labetalol had no change in the systolic BP prior to induction in the Labetalol groups at 5 min after labetalol injection. • Attenuation of Systolic BP at Laryngoscopy, at 1min, 3min, 7min & 10min after intubation is not statistically significant (decrease in Group C>Group B>Group A) • Preop systolic BP value was reached 3-5min after intubation

  42. SYSTOLIC BP

  43. CONCLUSION • Diastolic BP: • Preinduction iv labetalol decreased the diastolic BP prior to induction in the Labetalol groups (decrease in Group C>Group B>Group A) at 5 min after labetalol injection. But it is not statistically significant • Attenuation of Diastolic BP at Laryngoscopy, at 1min, 5min, 7min & 10min after intubation is statistically significant (decrease in Group C>Group B>Group A) • Preop diastolic BP was reached 2-3min after intubation

  44. DIASTOLIC BP

  45. CONCLUSION Both Group B & C showed attenuation of intubation stress response(HR, Diastolic BP & to a certain extent Systolic BP) compared to control group (Group A), but the difference between the two Labetalol groups is very less & not statistically significant. Hence Labetalol 0.25mg/kg is quiet effective & economical in attenuating stress response.

  46. THANK YOU

More Related