Labetalol Group Research Articles

Optimal treatment for women with acute hypertension in pregnancy; a randomized trial comparing intravenous labetalol versus nicardipine

ObjectivesBlood pressure control in severe hypertension of pregnancy is crucial for mother and neonate. In absence of evidence, guidelines recommend either intravenous labetalol or nicardipine. We compared the effectiveness and safety of these two drugs in women with severe hypertension in pregnancy. Study designWe performed an open label randomized controlled trial. Women with a singleton pregnancy complicated by severe hypertension (systolic ≥ 160 mmHg and/or diastolic ≥ 110 mmHg) requiring intravenous antihypertensive treatment were randomized to intravenous labetalol or intravenous nicardipine. The primary outcome was a composite adverse neonatal outcome defined as severe Respiratory Distress Syndrome (RDS), Broncho Pulmonary Dysplasia (BPD), Intraventricular Hemorrhage (IVH) IIB or worse, Necrotizing Enterocolitis (NEC), or perinatal death defined as fetal death or neonatal death before discharge from the neonatal intensive care unit (NICU).Based on a power analysis, we estimated that 472 women (236 per group) needed to be included to detect a difference of 15% in the primary outcome with 90% power. The study was halted prematurely at 30 inclusions because of slow recruitment and trial fatigue. ResultsBetween August 2018 and April 2022, we randomized 30 women of which 16 were allocated to intravenous nicardipine and 14 to intravenous labetalol. The composite adverse neonatal outcome was not significantly different between the two groups (25 % versus 43 % OR 0.28 (95 % CI 0.05–1.43), p = 0.12)). Respiratory distress syndrome occurred more often in the labetalol group than in the nicardipine group (42.9 % versus 12.5 %). Neonatal hypoglycemia occurred more often in the nicardipine group than in the labetalol group (31 % versus 7 %). Time until blood pressure control was faster in women treated with nicardipine than in women treated with labetalol (45 (15–150 min vs. 120 (60–127,5) min). ConclusionIn our prematurely halted small RCT, we were unable to provide evidence for the optimal choice of treatment for severe hypertension to improve neonatal outcome and/or to obtain faster blood pressure control. Differences in Respiratory distress syndrome and neonatal hypoglycemia between the groups might be the result of coincidental finding due to the small groups included in the study. A larger randomized trial would be needed to determine the safest and most efficacious (intravenous) therapy for severe hypertension in pregnancy. This study emphasizes the challenges of conducting a RCT for the optimal treatment for these women.

Anti-hypertensive therapy for preeclampsia: a network meta-analysis and systematic review

ABSTRACT Background Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality. Methods This network meta-analysis was registered with PROSPERO. We searched the PubMed, ClinicalTrials.gov. and Embase databases for studies published from inception to the 31st of March 2023. RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis (DMA) statistical analysis. Funnel maps, network meta-analysis (NMA), the surface under the cumulative ranking curve (SUCRA) to rank the different interventions and publication bias were generated by STATA 17.0 software. Results We included eight randomized controlled trials (RCTs) involving a total of 1192 women with PE; two studies were of high quality and six were of moderate quality. Eight interventions were addressed in the NMA. In the DMA, we found that blood pressure in the Ketanserin group were significantly higher than those in the Nicardipine group. NMA showed that blood pressure in the Dihydralazine group was significantly higher than that in the Methyldopa, Labetalol, Nicardipine and Diltiazem groups. And the blood pressure in the Labetalol group was significantly lower than that in the Nicardipine group. SUCRA values showed that Diltiazem was more effective in lowering blood pressure than other drugs looked at in this study. Conclusion According to the eight RCTs included in this study, Diltiazem was the most effective in reducing blood pressure in PE patients; Labetalol and Nicardipine also had good effects. Diltiazem is preferred for the treatment of patients with severe PE and high blood pressure.

A Comparative Study of Oral Nifedipine and Intravenous Labetalol for Acute Hypertensive Management in Pregnancy: Assessing Feto-Maternal Outcomes in a Hospital-based Randomized Control Trial.

Hypertension is one of the most common medical complications during pregnancy and a leading cause of maternal mortality and morbidity. Severe preeclampsia is defined as blood pressure (BP) >160/110 mmHg with warning signs such as headache, blurring of vision, and epigastric pain. Nifedipine (C17H18N2O6), labetalol (C19H24N2O3), and hydralazine (C8H8N4) are commonly used drugs, and all are recommended as first-line agents. Hydralazine is associated with a higher incidence of adverse outcomes, so oral nifedipine has been proposed as a first-line alternative to intravenous labetalol. Consequently, this study aims to compare the efficacy and safety of oral nifedipine with that of intravenous labetalol. The objective is to compare the ability/effectiveness of oral nifedipine and intravenous labetalol to normalize acute hypertension in severe preeclampsia and to assess the birth outcome. Relations between different factors were established by appropriate statistical tests. The p-value <0.05 was considered statistically significant. The study was conducted on 120 antenatal women with blood pressure ≥160/110 mmHg admitted to our hospital, a tertiary care center, from January 1st, 2020 to June 30th, 2021. Patients were randomized by a single blinding method to receive intravenous labetalol and oral nifedipine. The primary outcome measures were the time taken to control the blood pressure and the number of doses of drugs required. The secondary outcome measures were the birth outcome like a method of delivery, side effect profile, and the number of admissions in the neonatal intensive care unit. A total of 120 patients were included with 60 patients in each group. The labetalol group took 48.67 ± 17.80 minutes and the nifedipine group took 64.33 ± 9.81 minutes to achieve a target BP of <=140/90 mmHg (p< 0.05). No side effects were seen in 70% of patients in the labetalol group and 71.67% in the nifedipine group (p > 0.05). Intravenous labetalol is faster in restoring blood pressure in pregnant women with preeclampsia than oral nifedipine and may be used as a first-line drug in the acute control of blood pressure in a hypertensive emergency during pregnancy. More studies are needed in order to evaluate the findings from this pilot study in a large sample of patients.

Labetalol Ameliorates Experimental Colitis in Rat Possibly Through its Effect on Proinflammatory Mediators and Oxidative Stress.

Members of beta blockers drugs possess significant antioxidant activities. The current research is to assess the effect of the labetalol on acetic acid (AA-induced) colitis in rat model. Forty adult Wistar rats were separated into 4 groups, including the negative control group, AA group, AA + sulfasalazine (100 mg/kg/day) group, and AA + labetalol (300 mg/kg/day) group. Colitis was induced in rats by the interrectal installation of 2 mL of 4% (v/v) AA. Sulfasalazine and labetalol were administered orally for 7 days after 2 hours of induction. The following parameters were measured: disease activity index (DAI), histopa-thological changes and colon tissue homogenate concentrations of proinflammatory mediators IL-1β, adhesion molecules ICAM-1, and oxidative stress marker myeloperoxidase (MPO). The treatment with labetalol significantly reduced DAI and histopathological changes induced by AA. Also, labetalol markedly decreased the concentrations of IL-1β, ICAM-1, and MPO in colonic tissue that were increased by AA. The effects of labetalol were significantly lower than that produced by sulfasalazine as standard drug. Labetalol exerts ameliorative effects on disease activity and histopathological features of AA-induced colitis in rats possibly through antioxidant effects and inhibition of inflammatory mediators.

Efficacy of Dexmedetomidine and Labetalol for Induced Hypotension in Endoscopic Sinus Surgeries: A Randomised Clinical Study

Introduction: Functional Endoscopic Sinus Surgery (FESS) is one of the most commonly performed surgical procedures that requires minimal bleeding during the procedure. Dexmedetomidine, an alpha-agonist and labetalol, a betablocker, have been used to decrease intraoperative bleeding and provide optimal surgical conditions. Aim: To evaluate the efficacy of labetalol and dexmedetomidine on intraoperative blood loss and surgical conditions during FESS. Materials and Methods: The present randomised singleblinded clinical study was conducted in the Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal, India, from January 2020 to May 2021. Study was performed on 60 patients aged 18-60 years undergoing FESS. The patients were divided into two groups: Labetalol (L) or Dexmedetomidine (D). Heart rate and arterial blood pressure were measured after induction, during and at the end of the surgery. An assessment of bleeding was done by a blinded surgeon. Surgical field quality, surgeon satisfaction, emergence time, Aldrete score and any side effects were observed. Data were analysed using the Statistical Package of Social Sciences (SPSS) software version 17.0 for Windows and the unpaired student t-test. Results: In the total study population, the mean age in group D was 42.96±11.52 years and in group L was 47.33±10.97 years. In both groups, female patients were more prevalent than males (Group L: 53.3%; Group D: 60%). There was a significant decrease in heart rate in group D compared to group L during and after the operation. Mean Arterial Pressure (MAP) after induction (106.63±6.094 mmHg vs 114.80±6.272 mmHg), at extubation and after extubation for six hours was significantly higher in group L than in group D. The emergence time of group D was higher than that of the labetalol group. The surgical field quality and surgeon satisfaction were significantly higher in group D. Time to reach Aldrete score ≥9 (15.67±1.788 vs 11.23±1.654), time for first analgesic requirement and Ramsay sedation score were found to be higher in group D and were statistically significant. Conclusion: Both dexmedetomidine and labetalol can be used for controlled hypotension during FESS. Dexmedetomidine provides more haemodynamic stability and is ideal for creating a better surgical field during endoscopic surgeries.

Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation.

It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.

Haemodynamic effects of labetalol in isoflurane-anaesthetized dogs that received dexmedetomidine: A randomized clinical trial

ObjectiveTo test whether labetalol improved cardiovascular function in anaesthetized dogs injected with dexmedetomidine. Study designProspective, randomized, blinded, clinical trial. AnimalsA group of 20 healthy client-owned dogs undergoing ovariohysterectomy. MethodsEach dog received dexmedetomidine (5 μg kg–1) and methadone (0.2 mg kg–1) intramuscularly. General anaesthesia was induced with propofol and maintained with isoflurane in oxygen. All dogs were mechanically ventilated, and epidural anaesthesia with lidocaine was performed.Standard anaesthetic monitoring, invasive blood pressure, oesophageal Doppler and near-infrared tissue perfusion/oxygenation were applied. Peak velocity (PV), mean acceleration and stroke distance (SD) from the oesophageal Doppler were recorded. Arterial elastance (Ea) was calculated. Tissue oxygenation (rStO2) was also recorded.Prior to surgery, animals received either 0.1 mg kg–1 of labetalol intravenously (IV) over 60 seconds or the equivalent volume of saline. Data were recorded for 20 minutes.Age, weight and propofol dose were compared with a Wilcoxon rank-sum test. The effects of time, treatment and their interaction with haemodynamic and perfusion variables were analysed with mixed-effect models and Tukey’s post hoc tests. ResultsSignificant effects of the interaction between treatment and time were observed whereby heart rate (HR) was higher in dogs given labetalol (p = 0.01), whereas arterial blood pressure and Ea were lower (p < 0.01). Similarly, PV, SD and rStO2 were higher in the labetalol group, and significant effects were detected for the interaction between treatment and time (p < 0.01). Conclusions and clinical relevanceLabetalol at a dose of 0.1 mg kg–1 IV in dogs under general anaesthesia and administered a pre-anaesthetic medication of dexmedetomidine produced mild vasodilation (reduction of Ea), resulting in an increase in HR and left ventricular outflow. Although labetalol could be an effective option to achieve haemodynamic optimization after dexmedetomidine-induced vasoconstriction, future studies are needed to assess long-term effects.

Buffalo yogurt fermented with commercial starter and Lactobacillus plantarum originating from breast milk lowered blood pressure in pregnant hypertensive rats

Nutritional therapy, which may have advantages over medication, is being investigated as a novel treatment for pregnancy-induced hypertension. Several studies have shown that probiotic yogurt supplementation during pregnancy has beneficial effects on maternal and fetal health. In this study, fermented buffalo milk was produced with yogurt culture and Lactobacillus plantarum B, a probiotic isolated from healthy breast milk with high angiotensin-converting enzyme inhibitory activity. The fermentation conditions under which the angiotensin-converting enzyme (ACE) inhibitory activity reached 84.51% were optimized by the response surface method as follows: 2 × 106 cfu/mL of L. plantarum B, yogurt culture 2.5 × 105 cfu/mL, and 8 h at 37°C. The distribution of ACE inhibitory peptides from fermented buffalo milk and fermented cow milk were further analyzed by liquid chromatography-mass spectrometry. By searching according to the structural features of ACE inhibitory peptides, 29 and 11 peptides containing ACE inhibitory peptide features were found in fermented buffalo milk and fermented cow milk, respectively. To investigate the in vivo antihypertensive activity of fermented buffalo milk, 18 pregnant rats were divided into 3 groups (n = 6 in each group) and administered 10 mL of normal saline, yogurt (20 mg/kg), or labetalol hydrochloride (4 mg/kg) daily from the beginning of pregnancy to parturition. To induce hypertension, methyl nitrosoarginine (125 mg/kg) was injected subcutaneously every day from d 15 of pregnancy to the day of delivery. Blood pressure was not significantly changed in the yogurt and labetalol groups after induction of hypertension and was lower compared with the normal saline group, but there was no difference between the yogurt and labetalol groups. This implied that the buffalo yogurt had a preventive and antihypertensive effect in the pregnancy-induced hypertensive rat model. Further studies to determine the mechanism of action, as well as a randomized control trial, are warranted.

A Comparative Study of the Effect of Labetalol and Remifentanil on Pain Control After Bariatric Surgery.

Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects. This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital. This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes. There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043). Based on the study's findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.

Comparing Intravenous Labetalol and Intravenous Hydralazine for Managing Severe Gestational Hypertension.

Background Hypertensive disorders of pregnancy are the leading causes of both maternal morbidity and maternal mortality. Hypertensive disorders are acute obstetric emergencies, which refer to various life-threatening medical challenges known to develop during pregnancy, labor, and delivery,requiring urgent attention to reduce blood pressure (BP) for the benefit ofthe affected mothers and infants. Hydralazine and labetalol have been widely used as the first-line medications in themanagement of severe hypertension during pregnancy. However, the choice between these two drugs lacks clear evidence regarding their safety and superiority. Several studies have attempted to study intravenous (IV) labetalol versus hydralazine, but very fewsuch comparison studies havebeen conducted in Africa. Objective To compare the effectiveness of IV labetalol and IV hydralazine in reducing systolic and diastolic BP in pregnant women with severe hypertension. Also, to determine thetime required for hydralazine and labetalol to lower BP to ≤150/100 mmHg, the number of doses needed for each drug, and evaluating maternal and perinatal outcomes. Study design This study employed an open-label randomized clinical trial design conducted in the labor, delivery, and antenatal ward of the Central and Stella Obasanjo Hospital in Benin City. A total of 120 women with severe pregnancy-induced hypertension were randomly assigned to two groups: Group X, consisting of 60 pregnant women, received IV hydralazine at a slow rate of 5 mg for five minutes, repeated every 20 minutes (maximum of five doses) until a blood pressure of ≤150/100 mmHg was achieved. Group Y, also consisting of 60 pregnant women, received IV labetalol in escalating doses of 25, 50, 75, 75, and 75 mg (maximum of 300 mg) every 20 minutes until the blood pressure reached ≤150/100 mmHg. Statistical analysis was performed using SPSS version 23(IBMInc., Armonk, New York). Result IV hydralazine achieved the target BP in an average time of 45.80 +/- 25.17 minutes, while IV labetalol took an average of 72.67 +/- 41.80 minutes (p=0.001). The number of doses required to reach the target BP differed significantly between the two drugs. Hydralazine required an average of 1.72 +/- 0.904 doses, whereas labetalol required an average of 3.72 +/- 1.782 doses (p=0.0001). While 45% of women in the hydralazine group attained the target BP with a single dose of hydralazine, only 31.1% of women in the labetalol group were able to attain the target BP with asingle doseof labetalol(p=0.02). Overall, target BP was achieved in 55 out of 60 women (91.7%) who were randomized to receive IV hydralazine, whereas 45 out of 60 women (75%) who received IV labetalol achieved the target blood pressure. While hydralazine demonstrated more favorable results in terms of achieving target blood pressure, there were higher incidences of maternal adverse effects in the hydralazine group compared to the labetalol group. However, these adverse effects were not severe enough to warrant discontinuation of the medication. Conclusion IV hydralazine showed faster achievement of the target BP and a lower number of doses required compared to IV labetalol. Additionally, a higher percentage of women in the hydralazine group achieved the target BP with a single dose. However, there were more maternal adverse effects associated with hydralazine, although they were not severe. Perinatal outcomes did not differ significantly between the two groups.

Randomized Controlled Trial of Labetalol Versus Hydralazine, for Severe Hypertension in Obstetric Patients, at Tertiary Care Hospital of Karachi

Background: Blood pressure ≥160/110 mm Hg, is indication for urgent drug therapy in obstetric women, to prevent complications and deaths. There is limited data for comparison of Labetalol to Hydralazine in emergent treatment of severe pregnancy related hypertension. Methods: Randomized controlled trial, analyzed 184 women with severe hypertension at ≥28 weeks of pregnancy or within 72 hours after delivery, from October 2012 to September 2014. Ninety-two patients in each group received intravenous Labetalol or Hydralazine boluses, repeated every 10 or 20 minutes respectively (maximum 5 boluses). Outcome measures comprised blood pressure reduction &lt;160/110 mm Hg, mean arterial pressure, severe persistent hypertension, number of boluses, maternal hypotension, tachycardia, adverse effect on fetal heart, still birth and neonatal bradycardia. Data was collected on a semi -structured proforma and analyzed through SPSS version 20. Numeric outcome measures were compared by Mann Whitney U test or independent sample t test according to normality distribution. Qualitative measures were compared by Chi square or Fisher’s exact test. Level of significance was &lt;0.05 Results: There was no significant difference in reduction of systolic, diastolic blood pressure and severe persistent hypertension, between Labetalol and Hydralazine (p&gt;0.05). Tachycardia, palpitation, headache, were significantly higher (p &lt;0.05) in Hydralazine group. Adverse effects on fetal heart were not statistically significant. Numbers of boluses were significantly lower in labetalol group. Conclusion: Labetalol is equal to hydralazine in reducing severe pregnancy related hypertension. Maternal side effect profile of Labetalol is better, and it achieves blood pressure control with reduced boluses. Keywords: Pregnancy-induced hypertension, Hypertensive crisis, Labetalol, Hydralazine, Pregnancy, Preeclampsia, Antihypertensive agent.

Evaluation of intravenous infusion of labetalol versus magnesium sulfate on cerebral hemodynamics of preeclampsia patients with severe features using transcranial doppler

PurposeIt is essential to understand the underlying pathophysiological mechanisms of preeclampsia cerebral complications. This study aimed to compare the cerebral hemodynamic effects of magnesium sulfate (MgSO4) and labetalol in pre-eclampsia patients with severe features.MethodsSingleton pregnant women who suffered from late onset preeclampsia with severe features were enrolled and subjected to baseline Transcranial doppler (TCD) evaluation and then randomly assigned to either the magnesium sulfate group or labetalol group. TCD to measure middle cerebral artery (MCA) blood flow indices including mean flow velocity (cm/s), mean end-diastolic velocity (DIAS), and pulsatility index (PI) and to estimate CPP and MCA velocity were performed as basal measurements before study drug administration and at post-treatment one and six hours after administration. The occurrence of seizures and any adverse effects were recorded for each group.ResultsSixty preeclampsia patients with severe features were included and randomly allocated into two equal groups. In group M the PI was 0.77 ± 0.04 at baseline versus 0.66 ± 0.05 at 1hour and 0.66 ± 0.05 at 6 hours after MgSO4 administration (p value < 0.001) also the calculated CPP was significantly decreased from 103.3 ± 12.7mmHg to 87.8 ± 10.6mmHg and 89.8 ± 10.9mmHg (p value < 0.001) at 1 and 6 hours respectively. Similarly, in group L the PI was significantly decreased from 0.77 ± 0.05 at baseline to 0.67 ± 0.05 and 0.67 ± 0.06 at 1 and 6 hours (p value < 0.001) after labetalol administration. Moreover, the calculated CPP was significantly decreased from 103.6 ± 12.6 mmHg to 86.2 ± 13.02mmHg at 1 hour and to 83.7 ± 14.6mmHg at 6 hours (p value < 0.001). In terms of changes in blood pressure and the heart rate, they were significantly lower in the labetalol group.ConclusionBoth magnesium sulfate and labetalol reduce CPP while maintaining cerebral blood flow (CBF) in preeclampsia patients with severe features.Trial registrationThe institutional review board of the Faculty of Medicine, Zagazig University approved this study with the reference number (ZU-IRB#: 6353-23-3-2020) and it was registered at clinicaltrials.gov (NCT04539379).

Comparitive study of therapeutic effects of labetalol with methyldopa in hypertension in pregnancy induced hypertension and fetal outcome

In a country like India, where maternal mortality rate is still very high despite progress and development which has consistently been made in the health services, a big proportion is still deprived of it. Hypertension is the most common medical problem encountered during pregnancy. This study was undertaken to compare the efficacy of labetalol versus methyldopa in the treatment of pre-eclampsia and prevention of further complications. The present study had been carried out on antenatal booked 110 cases between 20 – 40 years of age who developed hypertension after 20 weeks period of gestation with or without oedema &amp; proteinuria or both, attending antenatal OPD or Emergency at Govt General Hospital, Nizamabad, from 1st December 2017 to 31may 2018. : Incidence of PIH in the present study is 7.23% in the booked population. Side effects of drugs were reported more in methyldopa group as compared to labetalol. Adverse foetal outcomes, especially IUGR and pre term babies are more in methyldopa group as compared to labetalol group. Emergency lscs cases are 14 out of 55 in labetalol group,22 out of 55 in methyldopa group were noted. Most common indication for emergency LSCS in both the groups was uncontrolled hypertension, but cases are more in methyldopa group. in Labetalol group 7 out of 55 underwent EL LSCS, in methyldopa group 6 out of 55 underwent LSCS. Total no of caesarean sections in labetalol group are 21 out of 55(32.7%),whereas in methyldopa group28 out of 55 (50.9%), so operative interference is more in methyldopa group when compared to labetalol group.: It concludes that labetalol is suitable for use during pregnancy to reduce maternal and fetal side-effects, so it has efficient hypotensive action.

Comparison of efficacy of intravenous labetalol and intravenous hydralazine for management of pre-eclampsia in pregnant women.

To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia.

Modulatory effect of ginger on skeletal malformations, cell cycle, apoptosis and structural changes in the liver of rat fetuses prenatally exposed to labetalol

BackgroundDrug-induced liver damage with clinical symptoms has been related to labetalol in a number of instances. In addition to having a wide range of anti-inflammatory and antioxidant qualities, ginger also includes biotrace that are crucial in the fight against disease and skeletal deformity. In this study, we hypothesized that prenatal supplementation of ginger (200 mg/kg) attenuates skeletal malformation and hepatotoxicity mediated by labetalol during the organogenesis period. The tested dams were divided into four groups: control, ginger (200 mg/kg), labetalol (300 mg/kg) and combined group (labetalol and ginger at the same doses).ResultsThe labetalol group showed various skeletal abnormalities represented by mandibular hypoplasia, costal separation and retardation in the ossification. Histological and ultrastructural examination of the fetal liver tissue revealed multiple pathological changes. DNA damage, G0/G1 cell cycle arrest and a high percentage of apoptosis were also detected in the fetal hepatocytes from labetalol groups through gel electrophoresis and flow cytometry using PI and annexin V/PI methods, respectively. Administration of ginger after labetalol caused an evident decrease in these skeletal malformations, structural changes, DNA damage, apoptosis and G0/G1 cell cycle arrest.ConclusionsIt can be concluded that ginger has great potential in attenuating the skeletal malformation, structural changes and cyto-genotoxicity of fetal hepatocytes upon prenatal exposure to labetalol.

PS-C30-5: COMPARISON OF INTRAVENOUS LABETALOL WITH ORAL NIFEDIPINE FOR CONTROL OF BLOOD PRESSURE IN SEVERE PREECLAMPSIA

Objective: The objective was to compare the effect of intravenous labetalol and oral nifedipine in severe preeclampsia in terms of time interval and the dose required to achieve the targeted blood pressure of 150/100 mm Hg. Design and method: Pregnant women at or beyond 28 weeks POG with live fetus and severe preeclampsia with blood pressure 160/110mmHg or more were enrolled and randomized into two groups. Women in group A received injection labetalol 20 mg and group B received 10 mg oral nifedipine. Blood pressure was monitored at an interval of 20 minutes. Intravenous labetalol for group A participants was repeated at 20 minutes interval in escalating doses of 40,80,80 and 80 upto maximum of 5 doses adding upto 300 mg until the target blood pressure was reached. In group B participants received oral nifedipine 10 mg orally at 20 minutes interval upto maximum of 5 doses adding upto 50 mg. If blood pressure was still not controlled then crossover of treatment was planned in the same manner after 2 hours of starting initial treatment such that participants receiving group A drug would receive group B and vice versa. Results: Total of 104 participants with 52 in each group were enrolled. The mean age of the participants was 24.01 ± 0.7 years. Primigravida were 82(78.8%) and 22(21.2%) were multigravida. The mean POG at enrollment was 36 to 37 weeks in both the groups (p = 0.9). The mean systolic blood pressure was 175.28 mmHg in the labetalol group and 175.23 in the nifedipine group (p = 0.7). The mean diastolic blood pressure was 119.57mmHg in labetalol group and 117.40 in the nifedipine group (p value = 0.8). Among labetalol group, maximum 76.9% participants achieved target blood pressure in 20 minutes after the first dose whereas 36.5% participants took 60 minutes with three doses to achieve target blood pressure in nifedipine group which was statistically significant (p = 0.00). Forty two (80.7%) had vaginal delivery and 10 (19.2%) participants had cesarean section in labetalol group. In nifedipine group 40(76.9%) participants had vaginal delivery and 12(23.1%) had cesarean section (p = 0.8). In both the groups Apgar score of newborn was normal for 82.7% of participants. Conclusion: Intravenous labetalol is more efficacious than oral nifedipine in terms of less time and low dose required to control blood pressure in severe preeclampsia.

Comparing the bleeding control effect of labetalol, remifentanil and dexmedetomidine during craniotomy; A randomised clinical trial

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy.

THE PREVALENCE OF EFFECTIVENESS OF BOLUS DOSE OF I/V HYDRALAZINE VERSUS I/V LABETALOL FOR THE EARLIER CONTROL OF BLOOD PRESSURE IN SEVERE PREECLAMPTIC PATIENT: A COMPARATIVE STUDY

To compare the efficacy of hydralazine and labetalol for the management of blood pressure in patients with severe preeclampsia to improve maternal and fetal outcomes. 6 months from March 2022 to September 2022 in the Department of obstetrics and gynecology, Liaquat University Hospital, Hyderabad and Razia Iqbal Hospital Multan, a Cross-sectional study was carried out. The study was conducted on 57 women diagnosed with severe preeclampsia. The subjects were divided into two groups. Group A was administrated I/V hydralazine bolus doses of 5 mg over 2 minutes with an interval of 20 minutes. Group B was administered I/V labetalol bolus doses of 20mg over 2 minutes at an interval of 10 minutes. The average age of the patients was 25.58±3.89 years. The efficacy of bolus dose of hydralazine (82.1%) and labetalol (75.9%) was statistically insignificant (p=0.56). The average time was 52 minutes the total hydralazine was 12.25 mg, in the case of the labetalol group the average time was 18.62 minutes, and the total dose was 68.28 mg. Both hydralazine and labetalol have similar efficacy as antihypertensive medications and can be used to treat hypertensive disorders in pregnant women.

Nicardipine versus Labetalol for Hypertension during Acute Stroke: A Systematic Review and Meta-Analysis.

Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke. MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods. Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112-0.438, P = 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077-2.113, I2 = 0.00%, P = 0.757). The quality of included studies was found to be low. More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions.

Effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in nasal surgery: a randomized controlled trial

BackgroundMaintenance of adequate peripheral perfusion during controlled hypotension is necessary for patient safety and improved surgical outcomes during controlled hypotension in nasal surgery. The hypothesis of this study was to investigate the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in patients undergoing nasal surgery.MethodsA total of 50 patients were randomly assigned into two equal groups in this double-blind clinical study: the magnesium sulfate group; received 40 mg/kg loading dose of intravenous (IV) magnesium sulfate followed by 10–15 mg/kg/h continuous IV infusion and the labetalol group; received 0.25 mg/kg loading dose of IV labetalol followed by 0.5–1 mg/kg/h continuous IV infusion to achieve a mean arterial blood pressure (MABP) of = 55–65 mmHg. The primary outcome was to compare the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion during nasal surgery. The secondary outcomes were the assessment of serum lactate, postoperative pain, time to the first call for pethidine (rescue analgesic) and total pethidine consumption.ResultsPPI was comparable between the groups at baseline, intubation, and 5 min. In contrast, magnesium sulfate group had a significantly higher PPI than the labetalol group. The magnesium sulfate group had a significantly higher MABP and heart rate compared to labetalol group. The time to reach the target MABP was significantly prolonged in magnesium sulfate than the labetalol group [21.6 ± 1.7 vs 6.9 ± 1.5] min. VAS scores were significantly lower for 2 hs postoperatively in the magnesium sulfate group than the labetalol group. The time to first call of pethidine was significantly prolonged in the magnesium sulfate group compared to the labetalol group [113.1 ± 5.2 vs 28.2 ± 1.5] min.ConclusionsMagnesium sulfate maintains wider PPI and offers better postoperative pain relief compared to labetalol during induced hypotension in nasal surgery.Trial registrationInstitutional review board approval (ref: 6601/20–12-2020).Clinicaltrial.gov (ref: NCT04688203, date of registration: 29 -12–2020).