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USE OF LABETALOL FOR ATTENUATION OF HYPERTENSIVE RESPONSE TO ENDOTRACHEAL INTUBATION IN PREECLAMPSIA PowerPoint Presentation
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USE OF LABETALOL FOR ATTENUATION OF HYPERTENSIVE RESPONSE TO ENDOTRACHEAL INTUBATION IN PREECLAMPSIA - PowerPoint PPT Presentation


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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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slide1

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

introduction
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
slide3
AIM
  • TO STUDY THE EFFECT OF LABETALOL ON STRESS ATTENUATION DURING LARYNGOSCOPY IN PREECLAMPTIC PATIENTS COMING FOR LOWER SEGMENT CAESAREAN SECTION
method
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
EXCLUSION CRITERIA
  • EVIDENCE OF ANTICIPATED DIFFICULT AIRWAY
  • BRONCHIAL ASTHMA
  • HEART BLOCK
  • DRUG ALLERGY
monitors
MONITORS
  • PULSEOXIMETRY
  • NON INVASIVE BLOOD PRESSURE
  • CAPNOGRAPHY
procedure
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
slide8

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
hemodynamic variables measured
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
slide10

HEART RATE

H

E

A

R

T

R

A

T

E

Time in minutes

slide11

SYSTOLIC BP

B

P

m

m

h

g

Time in minutes

slide12

DIASTOLIC BP

B

P

m

m

h

g

Time in minutes

slide13

SYSTOLIC & DIASTOLIC BP

B

P

m

m

h

g

Time in minutes

apgar score
APGAR SCORE
  • 1 MINUTE – 7-8/10
  • 5 MINUTES- 8-10/10
observation
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
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
slide17

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
slide18

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
SUMMARY
  • LABETALOL MINIMISES CARDIOVASCULAR STRESS RESPOSE TO LARYNGOSCOPY AND IUTUBATION
  • REDUCES SYSTEMIC VASCULAR RESISTANCE WITHOUT REFLEX TACHYCARDIA
  • LOW PLACENTAL TRANSFER
slide20

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
CONCLUSION
  • LABETALOL IS AN EFFECTIVE DRUG TO ATTENUATE THE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION IN PREECLAMPTIC PATIENTS
references
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
slide23

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