co authors prof. dr.i.chandrasekaran mdda prof. dr s.p.meenakshisundaram mdda asst prof. dr.g.vijaya...
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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
THANK YOU
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