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.

CO AUTHORSPROF. DR.I.CHANDRASEKARAN MDDAPROF. DR S.P.MEENAKSHISUNDARAM MDDAASST PROF. DR.G.VIJAYA MDAUTHOR DR.H.VIJAYALAKSHMI MD PGINSTITUTE OF ANAESTHESIOLOGYMADURAI MEDICAL COLLEGE

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

AIM

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

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

EXCLUSION CRITERIA

EVIDENCE OF ANTICIPATED DIFFICULT AIRWAY

BRONCHIAL ASTHMA HEART BLOCK DRUG ALLERGY

MONITORS

PULSEOXIMETRY NON INVASIVE BLOOD PRESSURE CAPNOGRAPHY

PROCEDURE

INDUCED WITH INJ.THIOPENTONE 5MG/KG , SUXA 1.5MG/KG

INTUBATED AND MAINTAINED WITH O

2,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

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

HEART RATE

HEART

RATE

Time in minutes

BPmmhg

Time in minutes

SYSTOLIC BP

DIASTOLIC BP

BPmmhg

Time in minutes

SYSTOLIC & DIASTOLIC BP

BPmmhg

Time in minutes

APGAR SCORE

1 MINUTE – 7-8/10 5 MINUTES- 8-10/10

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

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

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

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

SUMMARY

LABETALOL MINIMISES CARDIOVASCULAR STRESS RESPOSE TO LARYNGOSCOPY AND IUTUBATION

REDUCES SYSTEMIC VASCULAR RESISTANCE WITHOUT REFLEX TACHYCARDIA

LOW PLACENTAL TRANSFER

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

CONCLUSION

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

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

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

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