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CO AUTHORS PROF. DR.I.CHANDRASEKARAN MDDA PROF. DR S.P.MEENAKSHISUNDARAM MDDA

CO AUTHORS PROF. DR.I.CHANDRASEKARAN MDDA PROF. DR S.P.MEENAKSHISUNDARAM MDDA ASST PROF. DR.G.VIJAYA MD AUTHOR DR.H.VIJAYALAKSHMI MD PG INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE.

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CO AUTHORS PROF. DR.I.CHANDRASEKARAN MDDA PROF. DR S.P.MEENAKSHISUNDARAM MDDA

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  1. CO AUTHORS PROF. DR.I.CHANDRASEKARAN MDDA PROF. DR S.P.MEENAKSHISUNDARAM MDDA ASST PROF. DR.G.VIJAYA MD AUTHOR DR.H.VIJAYALAKSHMI MD PG INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE USE OF LABETALOL FOR ATTENUATION OF HYPERTENSIVE RESPONSE TO ENDOTRACHEAL INTUBATION IN PREECLAMPSIA

  2. INTRODUCTION • LARNGOSCOPY AND INTUBATION LEAD TO REFLEX CHANGES IN THE CARDIOVASCULAR SYSTEM • INCREASE IN BLOOD PRESSURE BY 40-50%, 20 % INCREASE IN HEART RATE • MAY LEAD TO CONSEQUENCES LIKE MYOCARDIAL ISCHEMIA ,CEREBRO VASCULAR ACCIDENTS, PULMONARY EDEMA • HENCE STRESS ATTENUATION IS NEEDED TO BLUNT THESE RESPONSES

  3. AIM • TO STUDY THE EFFECT OF LABETALOL ON STRESS ATTENUATION DURING LARYNGOSCOPY IN PREECLAMPTIC PATIENTS COMING FOR LOWER SEGMENT CAESAREAN SECTION

  4. METHOD • ETHICAL COMMITTEE APPROVAL • INFORMED WRITTEN CONSENT • OBSERVATIONAL STUDY • INCLUSION CRITERIA • 30 PREECLAMPTIC PATIENTS COMING FOR LOWER SEGMENT CAESAREAN SECTION • AGE- 20-35 YRS • WEIGHT 50-70 KGS

  5. EXCLUSION CRITERIA • EVIDENCE OF ANTICIPATED DIFFICULT AIRWAY • BRONCHIAL ASTHMA • HEART BLOCK • DRUG ALLERGY

  6. MONITORS • PULSEOXIMETRY • NON INVASIVE BLOOD PRESSURE • CAPNOGRAPHY

  7. PROCEDURE • PATIENT POSITIONED SUPINE WITH LEFT UTERINE DISPLACEMENT • PREMEDICATION • INJ.GLYCOPYRROLATE O.2MG • INJ.RANITIDINE 50 MG • INJ .METOCLOPROMIDE 10 MG • INJ.LABETALOL 20MG SLOW IV 5MTS BEFORE LARYNGOSCOPY

  8. INDUCED WITH INJ.THIOPENTONE 5MG/KG , SUXA 1.5MG/KG • INTUBATED AND MAINTAINED WITH O2,N2O • INJ.FENTANYL ,ATRACURIUM USED IN TITRATED DOSES • REVERSED WITH INJ .NEOSTIGMINE 40µ/KG, GLYCOPYRROLATE 10µ/KG • AFTER ADEQUATE ATTEMPTS PATIENTS WERE REVERSED AND EXTUBATED

  9. HEMODYNAMIC VARIABLES MEASURED • PULSE RATE • SYSTOLIC BLOOD PERESSURE • DIASTOLIC BLOOD PRESSURE • OXYGEN SATURATION PREOP, AT 1,3,5,10,20 ,30 ,60 ,120,180 MTS • APGAR SCORE

  10. HEART RATE H E A R T R A T E Time in minutes

  11. SYSTOLIC BP B P m m h g Time in minutes

  12. DIASTOLIC BP B P m m h g Time in minutes

  13. SYSTOLIC & DIASTOLIC BP B P m m h g Time in minutes

  14. APGAR SCORE • 1 MINUTE – 7-8/10 • 5 MINUTES- 8-10/10

  15. OBSERVATION • LABETALOL REDUCES HEART RATE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE 10-15 % FROM BASELINE • BLOOD PRESSURE LOWERING EFFECT IS MAXIMUM 5-15 AFTER ADMINISTRATION OF DRUG

  16. LABETALOL • α ,β BLOCKER • RATIO OF β : α 3:1 ORAL • RATIO OF β : α 7:1 IV • HALFLIFE 4-6 HRS AFTER IV, 6 -8 HOURS AFTER ORAL • ONSET IN 5 MTS , PEAK 5 – 15 MINUTES

  17. REDUCES SVR, REFLEX TACHYCARDIA PRODUCED BY VASODILATATION IS ATTENUATED BY BETA BLOCKADE • LIPID SOLUBLE ,50% PROTEIN BOUND • F/M RATIO -0.2- 0.8 • NO REBOUND HYPERTENSION

  18. IT CROSSES HUMAN PLACENTA TO PRODUCE CORD SERUM CONCENTRATION AVERAGING 40-60% OF PEAK MATERNAL LEVELS • LOW PLACENTAL TRANSFER IS DUE TO HIGH DEGREE OF IONISATION AT PHYSIOLOGICAL PH

  19. SUMMARY • LABETALOL MINIMISES CARDIOVASCULAR STRESS RESPOSE TO LARYNGOSCOPY AND IUTUBATION • REDUCES SYSTEMIC VASCULAR RESISTANCE WITHOUT REFLEX TACHYCARDIA • LOW PLACENTAL TRANSFER

  20. IT DOES NOT CHANGE UTEROPLACENTAL BLOOD FLOW DESPITE DROP IN BP DUE TO REDUCED PERIPHERAL VASCULAR RESISTANCE • REDUCES THE INCIDENCE OF HYALINE MEMBRANE DISEASE IN PREMATURE INFANTS BY INCREASING SURFACTANT PRODUCTION DUE TO ITS β2 AGONIST ACTIVITY

  21. CONCLUSION • LABETALOL IS AN EFFECTIVE DRUG TO ATTENUATE THE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION IN PREECLAMPTIC PATIENTS

  22. REFERENCES • SEVERE HYPERTENSION IN PREGNANCY –HYDRALAZINE OR LABETALOL A RANDOMISED CLINICAL TRIAL – EUROPEAN JOURNAL OF OBS AND GYN 128-2006 • CHANGES IN MATERNAL MIDDLE CEREBRAL ARTERY BLOOD FLOW VELOCITY ASSOCIATED WITH GA IN SEVERE PREECLAMPSIA-ANAES ANALGESIA 88 1999

  23. FETAL OUTCOME IN A RANDOMISED DOUBLE BLINDED CONTROLLED STUDY OF LABETALOL VS PLACEBO IN PIH –BJOG VOL 96 2005 • EFFECTIVE IN MANAGEMENT • NO APPARENT DISADVANTAGE FOR THE FETUS • LABETALOL VS METHYLDOPA IN THE TREATMENT OF PIH • INTERNATIONAL J OF OG VOL 49 1995 • QUICKER AND MORE EFFICIENT AT BP CONTROL , BENEFICIAL EFFECT ON RENAL BLOOD FLOW AND FEWER SIDE EFFECTS

  24. THANK YOU

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