Landiolol attenuates cardiovascular response at induction of general anesthesia for cesarean delivery

Abstract

General anesthesia for cesarean delivery is frequently associated with hypertension and tachycardia caused by tracheal intubation, which may lead to cardiac ischemia in susceptible patients or may cause harm due to increased intracranial pressure. To prevent these adverse events, we investigated the efficacy and safety of single-dose intravenous administration of landiolol, a short-acting selective β(1) receptor blocker, just prior to intubation. Patients scheduled for cesarean delivery under general anesthesia were randomized into two groups: landiolol (group L, n=32); and nontreated (group N, n=32) patients. After patients entered the operating room, blood pressure (BP), heart rate (HR), and fetal heart beats were monitored to ensure no problems were present, then thiopental 5mg/kg and rocuronium 0.9mg/kg were given. In addition, group L received a single dose of landiolol 0.2mg/kg. After tracheal intubation, anesthesia was maintained in both groups using sevoflurane. From before starting anesthesia to the time of delivery, BP, HR, need for additional treatment with uterotonic or vasopressor agents, and neonatal Apgar scores were recorded. Data were compared between groups. Group L showed significantly lower percentage changes in BP and HR than group N (p<0.05 each). Intraoperative blood loss, frequency of decreased uterine contraction, and fetal Apgar scores did not differ significantly between groups. In our study, landiolol reduced BP and HR changes during anesthesia induction, whereas no adverse effects on uterine contraction or the fetus were seen. These findings suggest landiolol provides adequate hemodynamic regulation during general anesthesia induction in patients undergoing cesarean delivery.