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USE OF LABETALOL FOR ATTENUATION OF HYPERTENSIVE RESPONSE TO ENDOTRACHEAL INTUBATION IN PREECLAMPSIA 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 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 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 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 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 H E A R T R A T E Time in minutes SYSTOLIC BP B P m m h g Time in minutes DIASTOLIC BP B P m m h g Time in minutes SYSTOLIC & DIASTOLIC BP B P m m h g 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