Labetalol Group Research Articles

Comparison of intravenous labetalol and hydralazine for severe hypertension in pregnancy in Northeastern Nigeria: A randomized controlled trial.

The objectives were to compare the efficacy and safety of intravenous hydralazine and labetalol for acutely lowering severe hypertension in pregnancy. This was a superiority parallel double-blinded randomized controlled trial conducted from October 2018 to June 2019 in two hospitals in Gombe, Nigeria. Pregnant women with a live singleton fetus at gestational age of at least 28weeks with severe hypertension were randomized (60 per group) to receive incremental doses of either intravenous labetalol (20mg; 40mg; 80mg; 80mg; and 80mg) or 10mg of intravenous hydralazine - up to a maximum of 5 doses - until the target blood pressure was achieved or the study was terminated. The main outcome measures were the mean reduction in mean arterial blood pressure and occurrence of persistent hypertension. Other endpoints were maternal side-effects, perinatal death, Apgar score at birth and SCBU admission. One hundred and thirteen patients' data were analyzed (fifty-six [56] in the hydralazine group and fifty-seven [57] in the labetalol group). There were no significant differences in the fall of the mean arterial blood pressure (labetalol; 24.19mmHg/hydralazine; 27.68mmHg) (p=0.192), maternal side effects, perinatal deaths, Apgar scores and SCBU admission between the two groups. Hydralazine, however, produced a more marked reduction in diastolic blood pressure than labetalol (p=0.012). Both labetalol and hydralazine are effective for acute blood pressure control in pregnancy with a similar safety profile. This study was self-funded and registered in the Pan African Clinical Trials Registry (www.pactr.orgPACTR202010738538062).

The Outcome of Lignocaine HCL, and Labetalol HCL in Low Doses for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation

Background: Recently lower dosages of lignocaine and labetalol have been proven to be beneficial in reducing perioperative adverse cardiovascular events. Objective: In this study our main goal is to evaluate the outcome of lignocaine HCL, and labetalol HCL in low doses for attenuation of hemodynamic response to laryngoscopy and intubation. Method: This prospective study was done at tertiary hospital from January 2020 to December 2021. In this study 100 consenting patients of age group 31–60 years of either sex and various general surgical procedures under endotracheal anesthesia were included in this study. During the study, 100 patients were randomly divided into two groups depending on the study drug to be given: Group LB: Injection labetalol HCL 0.25 mg/kg body weight diluted to 10 ml with 0.9% saline was given IV 5 min before intubation over 60 s, n=50 and Group LG: Injection lignocaine HCL 1 mg/kg body weight diluted to 10 ml with 0.9% saline was given IV 5 min before intubation over 60 s, n=50. Results: during the study, majority were belonged to 41-50 years age group and 60% were male. The increase in mean HR was observed in LG groups but least in labetalol group. Besides that, increase in SBP in group lignocaine but not in labetalol group whereas DBP increased in all both groups almost similarly. RPP in peri-intubation period was most stable in group LB whereas mean atrial pressure increase in group LG was higher than that in group LB. Conclusion: Labetalol was found to be superior for the reduction of HR, SBP, DBP, mean arterial pressure, and RPP during and after laryngoscopy and endotracheal intubation in both intra- and inter-group comparisons.

Intravenous Labetalol vs Intravenous Clonidine for Attenuation of Haemodynamic Responses during Laryngoscopy and Intubation in Controlled Hypertensive Patients Undergoing General AnaesthesiaA Randomised Clinical Trial

Introduction: Laryngoscopy and endotracheal intubation during general anaesthesia are associated with haemodynamic surges which can be detrimental, particularly if there is preexisting hypertension or cardiovascular disease. Intravenous (i.v.) labetalol, a β-adrenergic blocker with additional α1- adrenoceptor blocking activity, and clonidine, a centrally acting α2 agonist, are known to attenuate this haemodynamic response. Aim: To compare the effects of i.v. labetalol and clonidine in attenuating haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients. Materials and Methods: This single centre, parallel-group, double-blind, randomised clinical trial was conducted in the Surgery Operation Theater (OT) of Midnapore Medical College, District Paschim Medinipur, West Bengal, India, from February 2018 to August 2019. The study included 90 adult patients of either sex, who were randomly allocated to receive either clonidine 1 mcg/kg or labetalol 0.15 mg/kg by intravenous route. After recording baseline parameters, patients were preoxygenated with 100% oxygen for 3 min and the study drug was given 5 min prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) and the rate pressure product were recorded prior to induction, at the time of intubation and 1, 3, 5, and 10 min after intubation. General anaesthesia maintenance was done in a similar manner in both groups. Two-sample t-test was used to assess significance of difference in means between independent samples. Fisher’s exact test was employed for comparing categorical data. Analysis was two-tailed and p-value<0.05 was considered statistically significant. Results: Both the groups were evenly matched at baseline with respect to age and sex as well as standard anthropometric parameters (p-value>0.05). Both drugs were able to attenuate the expected rise in HR following intubation but labetalol was more effective than clonidine throughout the postintubation period. SBP and DBP were comparable between the two groups at baseline but underwent greater attenuation in the labetalol group at intubation and subsequent measurements. The differences were around 10 bpm for HR, 20-30 mmHg for SBP and 10 mmHg for DBP, in favour of labetalol. Adverse events like bradycardia, hypotension, sedation or undesirable ECG changes were not encountered. Conclusion: Intravenous labetalol is more effective than i.v. clonidine in controlling haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients undergoing general anaesthesia without any complications

Comparison of Low dose Labetalol Versus Low dose Lignocaine for Attenuation of Pressure Response During Intubation Under General Anaesthesia

Objective: To compare the mean heart rate (HR) and mean arterial pressure (MAP) after 5 minutes post intubation with low dose Labetalol versus low dose Lignocaine during intubation under general anaesthesia. Patients and Methods: A total number of 60 patients with age 18-40 years who were planned for elective surgery under general anesthesia were included in this comparative study. There were two equal groups; in group A patients 0.25mg/Kg intravenous labetalol was given 5 minutes before intubation, in group B patients, intravenous Lignocaine 1 mg/Kg was given. MAP and HR were noted at baseline and after 5 minutes of intubation. Results: Mean age 31.03±6.34 years. Mean weight of patients was 67.45±10.60 kgs. There were 537 (61.67%) male patients and 23 (38.33%) female patients. Heart rate at 5 minutes post intubation in patients with labetalol group was 78.43±6.41 beats/min versus 88.37±6.73 beats/min in patients in lignocaine group (p-value <0.001). MAP at 5 minutes post intubation in patients with labetalol group was 94.20±6.12 mm of Hg and 103.00±4.41 mm of Hg in patients in lignocaine group (p-value of <0.001). Conclusion: Increases in hemodynamic variables are always linked with laryngoscopy and endotracheal intubation. To reduce the effects of endotracheal intubation on patients having general anesthesia, labetalol is a safe and effective medication. Keywords: tracheal intubation, Labetalol, Lignocaine, Mean arterial pressure, heart rate.

Blood Pressure Control in Acute Stroke: Labetalol or Nicardipine?

PurposeTo assess the safety and efficacy of continuous infusion (CIV)-labetalol compared to -nicardipine in controlling blood pressure (BP) in the acute stroke setting. MaterialsPatients were eligible if they had a diagnosis of an acute stroke and were administered either CIV-labetalol or CIV-nicardipine. Study outcomes were assessed within the first 24 h of the antihypertensive infusion. ResultsA total of 3,093 patients were included with 3,008 patients in the CIV-nicardipine group and 85 in the CIV-labetalol group. No significant difference was observed in percent time at goal BP between the nicardipine (82%) and labetalol (85%) groups (p = 0.351). There was also no difference in BP variability between nicardipine (37%) and labetalol (39%) groups (p = 0.433). Labetalol was found to have a shorter time to goal BP as compared to nicardipine (24 min vs. 40 min; p = 0.021). While CIV-nicardipine did have a higher incidence of tachycardia compared to labetalol (17% vs. 4%; p <0.001), the incidence of hypotension (13% vs. 15%; p = 0.620) and bradycardia (24% vs. 22%; p = 0.797) were similar. ConclusionsThese results indicate that CIV-labetalol and CIV-nicardipine are comparable in safety and efficacy in controlling BP for patients with acute stroke.

Labetalol versus Alpha Methyldopa for Control of Pregnancy Induced Hypertension

ABSTRACT Background: Hypertension is a common medical problematic faced throughout pregnancy and is accompanied with raised risks of opposing consequences, Objective: This work aimed to match the effectiveness of labetolol and alpha methyldopa in blood pressure (BP) control in women with Pregnancy Induced Hypertension (PIH). Methods: This observational study was performed at Department of Obstetrics and Gynecology of AL- HUSSIEN University Hospital and Suez General Hospital after obtaining an approval from institutional board review of Al Azhar University Faculty of Medicine. Results: A significant change among the studied group in regard to mean drop in SBP and DBP, and Period needed to control BP in labetalol group was significantly lower compared to α-Methyldopa group, Conclusion: Hypertensive diseases throughout gestation are a main reason of morbidity and death all over the world. Antihypertensive drugs have a significant function in treating maternal BP. The current work approves the preceding results that labetalol is an operative and secure medication for usage faster in accomplishing acceptable in controlling of BP in PIH, in our work we found that Labetalol controls systolic and diastolic Bp more quickly and efficiently than Methyldopa.

Oral Nifedipine Versus Intravenous Labetalol in the Management of Severe Pregnancy Induced Hypertension: A Randomized Control Trial

Background : Pregnancy-also known as gestation is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can occur through assisted reproductive technology protedures. To assess the efficacy of oral Nifedipine and I/V Labetalol for lowering BP in severe PIH after 28 weeks of pregnancy.&#x0D; Materials and methods: In this study 100 subjects were selected with severe pregnancy induced hypertension as per inclusion criteria. After taking informed written consent they were randomly allocated into two groups, A &amp; B. Group A received initially tablet nifedipine 10 mg orally with repeated doses of 20 mg every 20 minutes upto five doses while Group B received intravenous labetalol 20 mg initially followed by escalating doses of 40, 80, 80 and 80 mg every 20 minutes until the therapeutic goal blood pressure Systolic £ 150 mmHg &amp; diastolic £ 100 mmHg was achieved. Primary outcomes were the time interval and the number of doses needed to achieve a blood pressure of £ 150/100 mmHg, Secondary outcomes were fetomaternal safety, efficacy and side effects of both drugs. The outcomes were recorded in a preformed data collection sheet. All the data were analyzed by computer based software SPSS version 19 (SPSS Inc, Chicago, IL, USA). P &lt;0.05 at 95% level was taken as statistically significant.&#x0D; Results: A total of 100 patients of different ages with mean age of 27.41 years were taken in the study. Primi patients were more in Group A the Group B and mode of delivery was commonly caesarian section (66% vs 78%) in both groups. Proportion of target BP achievement were 100% in Group A and it was 72% in Group B. Need of drug dose and time of reduction was found significantly less among Group A women. Change of mean ± SD, SBP was more rapid in Group A ( 174.90 ± 20.01 vs 158.40 ± 11.13) women who were on Group A oral nifedipine than Group B ( 179.80 ± 16.54 vs 167.40 ± 15.02) i/v labetalol group after first dose. It was same for DBP also. Need of mean dose were less in group A than Group B (1.72 vs 3.30) also total time needed to achieve target BP was less in Group A (34.40 vs 66.0 mins). There was no need of doses exceeding third dose who were on oral nifidipine than i/v labetolol. Both maternal and fetal heart rate was not influenced by both the drugs. Side effects of drugs were found more in Group B (8% vs 4%) and fetal death also more common in there (8% vs 16%). Value of APGAR scores was found higher both at 1 minute and at 5 minutes among Group A neonates than Group B. Significant urine output volume was found in Group A patients than Group B at first hour.&#x0D; Conclusion: Oral nifedipine and intravenous labetalol both the regimens are found to be effective in the management of severe PIH. But Nifidipine lowers blood pressure more rapidly with fewer doses with minimum fetomaternal side-effects.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 55-61

Efficacy and Safety of Intravenous Labetalol in Acute Hypertensive Crisis in Children

To determine the efficacy and safety of intravenous (IV) labetalol in the management of hypertensive crisis in children. A retrospective chart review of 56 consecutive children (age > 1 mo to ≤12 y) with hypertensive crisis admitted to a pediatric intensive care unit (PICU) from July 2009 to 2019. The proportion of children attaining the primary endpoint (target 95th percentile in >12 to ≤48h) was significantly more in the group receiving labetalol as first-line or add-on (n = 23) as compared to those not receiving labetalol (n = 33) (62% vs. 30.3%, p = 0.03). Higher proportion of neurological recovery was seen in the labetalol group (56.2% vs. 18.7%, p = 0.02). The proportion of children with hypotension before 12h was similar in both treatment groups (13% vs. 15%, p = 0.82). The practice variations between two periods of 5y each (2009-2013 and 2014-2019) showed significantly more use of labetalol in the latter cohort (53% for 2014-2019 vs. 25% for 2009-2013, p = 0.03). Labetalol, when used alone or as an add-on drug, was more efficacious than IV nitroprusside/nitroglycerine in attaining the primary endpoint in children up to ≤12 y of age with hypertensive crisis. Labetalol was safe and associated with higher neurological recovery.

184 Among pregnant women with chronic hypertension, do outcomes differ between those on nifedipine versus labetalol?

Per ACOG, nifedipine and labetalol are first-line antihypertensive agents for hypertension management in pregnancy. This study aims to identify if perinatal outcomes differ in pregnant women with chronic hypertension managed on nifedipine versus labetalol. This is a secondary analysis of a large, NIH-funded retrospective study evaluating the effect of iatrogenic delivery at 34-38 weeks’ gestation on perinatal outcomes among women with liveborn singletons who had fetal growth restriction (FGR), maternal diabetic disorders and/or hypertensive disorders. Chart abstractions were completed by trained research nurses. In this secondary analysis, the study population was limited to women with chronic hypertension managed on nifedipine or labetalol; women on both medications were excluded. The primary outcome was development of superimposed severe preeclampsia. Secondary outcomes included FGR and neonatal outcomes. All outcomes were compared using Fisher’s exact and Wilcoxon rank-sum tests between women taking nifedipine or labetalol. 587 women with chronic hypertension managed on either nifedipine (n=48) or labetalol (n=539) were included for analysis. More black women and fewer white women were prescribed nifedipine than labetalol (p <0.001) but there were no other differences in maternal demographic factors or medical comorbidities. Development of severe preeclampsia did not differ between the nifedipine and labetalol groups (11.7% and 18.6% respectively, p=0.22; adjusted relative ratio 0.73 (0.36,1.49)). Similarly, there was no difference in development of FGR, birth weight, NICU admission, or composite neonatal morbidity. Gestational age at the time of severe preeclampsia diagnosis or of delivery did not vary between the two groups. In this retrospective study, comparable maternal and neonatal outcomes among women using nifedipine and labetalol support ACOG guidelines recommending either as a first-line agent. These findings should be confirmed prospectively in order to fully support ACOG’s recommendation of either as a first-line agent.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Genetic characterization and assessment of demographic bottleneck in Caspian horse population.

The aim of this study was to evaluate genetic characterization of the Caspian horse population using microsatellite markers. This study determined the efficiency of microsatellite markers for conservation plans and breeding strategies in Caspian horse population. For this purpose, 120 Caspian horse samples including 95 adults and 25 foals were genotyped by using seventeen microsatellite markers recommended by ISAG. The number of allele per locus varied from 5 (HMS01 and HTG07) to 9 (HTG10) with an average value of 7.41. The observed heterozygosity and the expected heterozygosity ranged 0.505-0.831 (mean 0.684), from 0.615-0.835 (mean 0.748) respectively. PIC value ranged from 0.716 (HMS01) to 0.834 (AHT04) with average 0.787. The total exclusion probability of the 17 microsatellite loci was 0.9999. Low values of Wright's fixation index, Fis (0.084) indicated low levels of inbreeding. A significant heterozygote excess on the basis of different models suggested that Caspian horse population has decreased to low numbers in the past, but a bottleneck event is still scrutable, and its number has recently increased is not in mutation drift equilibrium. The present study contributes to our knowledge of the genetic diversity of the Caspian horse population and helps to define its genetic conservation strategies.

Comparison of Labetalol and Nitroglycerine,s Effects on Deliberate Hypotension in Septo-Rhinoplasty Ssurgery, a Randomized Clinical Trial

Introduction:Bleeding during ENT surgeries may contribute to impaired view. The less blood in surgical filed, the better quality and more surgeon�s satisfaction is expected. Deliberate hypotension is a technique to achieve this goal. Current study aimed to evaluate effects of Labetalol andNitroglycerinein deliberate hypotension. Methods: It is a double blind RCT,conducted on 68 septo-rhinoplastypatients in ENT ward, Imam Reza Hospital, Mashhad, during 2017 after obtaining written consent. Patients were assigned to receive Nitroglycerine (n=32) or Labetalol (n=36) randomly. Mean arterial pressure and HR monitored. Total blood loss was estimated and recorded at a Boezaart Surgical Field Grading Scale. Surgeon�s satisfaction with surgical field condition was measured after the procedures using a questionnaire at a 5-point Likert scale. Results: Two studied groups were similar in demographic characteristics. Heart rate was lower in Labetalol group (P <0.001) significantly, but there was no significant difference between two groups regarding mean arterial pressure variations (P = 0.12). Surgeon�s satisfaction with the operation condition was not significantly different (P= 0.28). According to Boezaart scale, no statistically significant difference was found between groups with regard to bleeding volume (P= 0.75). Patients in Labetalol group received less additive drugs to maintain hypotension than another group (P=0.025). Conclusion: Although Labetalol and Nitoglycerine are not much different in reducing blood loss or providing a better view of surgical field but Labetalol is superior in maintaining heart rate and hypotension and noneed toadditive drug.

Attenuation of haemodynamic response to laryngoscopy and endotracheal intubation a comparative study between I.V. labetalol and I.V. lignocaine

One of the most common procedures performed by the anaesthisiologists is the Endotracheal Intubation. During this procedure, hemodynamic changes, which may be rapid and dramatic and adverse to the patient may occur. Lignocaine is an excellent drug for the attenuation of pressor events and Labetalol is a potent antihypertensive drug. 50 patients between the ages 18 to 60 years who were scheduled for various procedures under general anaesthesia with ASA Grade I status were included into the study and divided into 2 groups of 25 each. One group was given intravenous Labetalol 0.75mg/kg 10 minutes before intubation and the other group received intravenous injection of Lignocaine hydrochloride (without preservative) 2% in a dose of 1.5 mg/kg over a period of 10 seconds, before 90 seconds of laryngoscopy and intubation. The parameters were lower in Labetalol group (P&amp;#60;0.05) compared to the lignocaine group. The arterial pressures in the Labetalol group attained basal value, and heart rate nearing basal value. The arterial pressures in the Lignocaine group were slightly higher a than basal values and the heart rate is higher than baseline value.Labetalol given intravenous was more advantageous compared to other methods for attenution of hemodynamic changes after laryngoscopy and intubation as it has a good attenuation of pressor response and heart rate and provides a good intra operative profession against haemodynamics response to surgical stimuli.

Comparison of Labetalol, Nitroglycerine and High Dose Propofol for Induced Hypotension in Functional Endoscopic Sinus Surgery in Massive Nasal Polyposis: A Randomized Trial

Background: Objective: The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia. Methods: One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale. Results: The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001). Conclusion: Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women.

Response to acute treatment of severe hypertension during pregnancy in Asian women was not known. Labor and delivery checklists of Thai women treated with intravenous hydralazine or labetalol for systolic blood pressure (SBP) ≥ 160 or diastolic blood pressure (DBP) ≥ 110 mmHg from January 2011 to December 2013 were reviewed as parts of an audit. Primary outcome was prompt achievement of SBP 140-150 and DBP 90-100 mmHg after the first bolus. Secondary outcomes were medication-related undesired effects. The mean ± standard deviation age and prevalence of chronic hypertension in hydralazine (n = 62) versus labetalol (n = 64) groups were 32.5 ± 6 versus 29.9 ± 6.8 years and 50% versus 21.9%, respectively (P < .05). Magnesium sulfate was promptly administered on admission to every woman to prevent seizure. Targeted blood pressure was timely achieved in 41.9% and 67.2% of the hydralazine and labetalol groups, respectively (P < .05). Nonreassuring fetal heart rate occurred in 51.6% and 32.8% of the hydralazine and labetalol groups, respectively (P = .05). The prevalence of cesarean section and Apgar score < 7 were not significantly different (P > .05). Real-life clinical experiences suggested significant advantages of intravenous labetalol over hydralazine in pregnant women with severe hypertension.

Intra-Arterial Labetalol and Nitroglycerin in Preventing Radial Artery Spasm Following Transradial Angiography: A New Approach

Background: Radial artery spasm (RAS) resulted from decreasing blood flow and activation of vasomotor system leads to a decrease in artery diameter, perfusion and patency, and increase the risk of procedure failure. In this study, we investigated the effects of intra-arterial administration of nitroglycerin and labetalol on radial artery diameter, RAS, and pain intensity in patients undergoing diagnostic radial angiography. Methods: Sixty-four patients randomly enrolled into one of the nitroglycerin (150 μg) or labetalol (500 μg) groups. The radial artery size, and the incidence of RAS were measured before, immediately after puncture, and at the end of treatment. Pain intensity was evaluated using a visual-analog-scale (VAS) at the end of the procedure. Hemodynamic status before, and during the procedure was also recorded. Results: Labetalol causes a significantly larger increase in radial diameter than nitroglycerin immediately after intra-arterial injection (2.24±0.58 mm vs. 1.65±0.39 mm, P-value&lt;0.001). The rate of RAS immediately after vasodilator administration in the labetalol group was 3.1% vs. 12.5% in the nitroglycerin group (P-value=0.355), but the overall incidence (immediately after administration+ at the end of procedure) did not show a statistically significant difference (53.125% vs 31.25% respectively, P-value=0.076). The VAS score did not show a significant difference between two groups (1.15±0.44 in nitroglycerin vs. 1.50±0.91, P-value=0.063). Conclusion: Labetalol increases radial artery diameter more than nitroglycerin. However, the efficacy of labetalol in terms of RAS incidence, and patients’ pain was similar to nitroglycerin. Therefore, intra-arterial labetalol could be considered as one of the therapeutic options in clinical practice in order to reduce RAS and procedure failure.

Comparative study of oral nifedipine versus intravenous labetalol in severe hypertension in pregnancy: A randomized controlled study

To compare the efficacy of oral nifedipine with intravenous labetalol in the treatment of severe hypertension in pregnancy.It was a double-blind, randomized, controlled study conducted in pregnant women with blood pressure ≥160/110 mm Hg. Total 60 patients were enrolled from October 2016 to September 2017. Patients were randomized to receive nifedipine (10 mg tablet orally up to five doses) and intravenous placebo saline injection or intravenous labetalol injection in doses of 20, 40, 80, 80, and 80 mg and a placebo tablet every 20 minutes until the target blood pressure of ≤ 150/100 mmHg was achieved. The primary outcome of the study was time necessary to achieve target blood pressure. Secondary outcome were number of doses required, onset of labour, mode of delivery, adverse maternal and neonatal effects, side effect, and perinatal outcome. The time to achieve the blood pressure goal was significantly shorter with nifedipine (mean ± SD, 34.67 ± 20.297 minutes) than with labetalol (52.00 ± 29.054minutes; P &amp;#60;.017). Nifedipine group required significantly lower doses (mean ± SD, 1.73±1.015) as compared to labetalol (2.60±1.453, p&amp;#60;0.017). Urine output was significantly increased in nifedipine group (mean ± SD, 2296 ± 210.483 ml) compared with labetalol group (1374 ± 155.798 ml, P &amp;#60; .0001) and remained significantly increased 24 hours after initial administration. No patients required crossover therapy. The a dverse effects were infrequent. There were no significant differences in maternal age, gestational age, and blood pressures between the groups. Oral nifedipine and intravenous labetalol both are effective in the management of severe hypertension of pregnancy; however, nifedipine controls hypertension more rapidly with less number of dos es and was associated with a significant increase in urinary output.

Attenuation of sympathoadrenal response to direct laryngoscopy and intubation using 0.25mg/kg injection labetalol

: Direct laryngoscopy and endotracheal intubation evokes autonomic disturbances in the form of tachycardia, raise in blood pressure, intracranial, and intraocular pressure.Thus the present study was undertaken to evaluate the efficacy of injection Labetalol 0.25mg/kg body weight in the attenuation of sympathoadrenal response to direct laryngoscopy and endotracheal intubation.: The study was conducted on 60 participants belonging to ASA grade 1 or 2 aged between 18 – 55 yrs undergoing elective surgeries under general anaesthesia. The study population was randomly divided into 2 groups with 30 subjects in each group.Group LAB (Labetalol group) – received 0.25mg/kg body weight diluted upto 10ml with normal saline intravenously, over 10minutes using a syringe pump, given 10minutes before induction.Group CR (Control) received 10ml of normal saline intravenously.The study drug was administered over 10 minutes using syringe pump followed by induction with inj Thiopentone 5mg/kg body weight and inj vecuronium 0.1mg/kg body weight three minutes prior to laryngoscopy and intubation. HR(Heart rate), Systolic arterial pressure, diastolic arterial pressure, MAP(mean arterial pressure) were recorded at basal, 2 minutes, 5 minutes, 8 minutes after study drug infusion, before induction, after induction, 1, 2, 3, 5, 10, 15 minute after laryngoscopy and intubation.: The result showed statistically significant (p&amp;#60;0.05) decrease in Heart rate, Systolic arterial Pressure, Diastolic arterial pressure and Mean arterial pressure in Group LAB compared to Group CR at all the time intervals.In the present study, it was found that inj Labetalol 0.25mg/kg body weight had effectively attenuated the sympathoadrenal response to laryngoscopy and intubation.

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

BackgroundDeliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin- versus labetalol-induced hypotension on peripheral perfusion.MethodsThe present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55–65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss.ResultsForty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2–2.5] versus 1.5 [IQR 1–2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings.ConclusionNitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.Trial registrationThe study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.

Comparison of Labetalol and Nitroglycerine on Intraoperative Bleeding in Patients Who Underwent Dacryocystorhinostomy

The bleeding during dacryocystorhinostomy (DCR) surgery is one of the main complications that led to the surgeon’s dissatisfaction and increased the duration of the operation. The current study aimed at comparing the effects of labetalol and nitroglycerine (TNG) on blood loss and the surgeon’s satisfaction during DCR. The current prospective and randomized study enrolled 60 patients candidate for DCR under local anesthesia and sedation and divided into two groups. When the surgeon dissatisfied with bleeding during the operation, patients in the labetalol group received labetalol infusion at a rate of 0.5-2 mg/kg and compared with the subjects in the TNG group that received TNG infusion at a rate of 0.1 µg/kg/min. Additionally, the surgical condition was assessed by the surgeon using the average category scale (ACS) and surgeon’s satisfaction by a scoring system. The average bleeding in the labetalol group was 140.5±24.5 ml versus 170.4±24.6 ml in the TNG group, respectively (P=0.001). The average category scale for the labetalol group was better than the TNG group during all the time of operation. The surgeon satisfaction score during the operation was more in the labetalol group (3.4 in the labetalol group versus 2.8 in the TNG group, respectively). Labetalol was better than TNG for controlling bleeding during DCR procedure because of decreasing surgical blood loss and optimum operative condition.

SUN-174 EFFICACY AND SAFETY OF INTRAVENOUS LABETALOL FOR HYPERTENSIVE CRISIS IN CHILDREN

Hypertensive crisis is uncommon in children. American Association of Pediatrics acknowledges the lack of robust evidence-based management guidelines for the same. Most data on the choice of drugs is extrapolated from adults and small case series in children. The objectives of this study were to determine the efficacy and safety of IV labetalol as a first-line agent or an add on drug compared to IV nitroprusside/nitroglycerine in the management of hypertensive crisis in children. A retrospective chart review of 56 consecutive children (age 1 month to ≤ 12 years) with hypertensive crisis admitted to pediatric intensive care unit (PICU) during a 10-year period (July 2009- 2019) was done. Data with respect to baseline demographics, clinical presentation, etiological workup, treatment details, and blood pressure (BP) trends were recorded. The choice of antihypertensive agents was left to the clinician's discretion. The proportion of patients, attaining target BP (95th percentile) in >12 to ≤ 48 hours after admission was taken as primary endpoint. The secondary endpoints were PICU needs, morbidity, and mortality. The median age of the children was 7 years (range 1-12). Hypertensive crisis comprised < 1 % of PICU admissions. Most crisis presented as hypertensive emergency (89%) and had renal etiology as the leading cause (61%). The proportion of children attaining the primary endpoint was significantly more in the group receiving labetalol (n=23) as compared to those not receiving labetalol (n=33) (62% vs. 29%, p < 0.0001). The proportion of children having precipitous fall in BP before 12 hours, leading to hypotension was similar in both treatment groups (13% vs 15%). The PICU needs for ventilation (0% vs 27%, p < 0.0001), renal replacement therapy (0% vs 9%, p = 0.003) and raised intracranial pressure (ICP) (0% vs 9%, p = 0.003) were significantly less in the labetalol group. The central nervous system (CNS) morbidity was also significantly reduced in the labetalol group (41% vs. 9%, p < 0.0001). One child compared to three died in the labetalol and non-labetalol group respectively (4.3% vs. 9%, p = 0.2). The data were also analyzed for practice variations between two periods of five years each (2009-2013 and 2014-2019). There latter cohort showed significantly more use of labetalol (74% for 2014-2019 vs. 26% for 2009-2013, p < 0.0001). Labetalol, when used alone or as an add on drug was more efficacious than IV nitroprusside/nitroglycerine in attaining the primary endpoint. There was a lesser need for ventilation and renal replacement therapy with labetalol. The CNS morbidity at discharge was also lesser. The propensity to hypotension was however similar in both groups. There is only one study looking at the safety and efficacy of labetalol in children with hypertensive crisis up to ≤ 24 months of age. Ours is the only study to the best of our knowledge in children up to 12 years of age. However, our study suffers from the inherent problems of a retrospective analysis. In conclusion, our study shows that labetalol is safe and efficacious in hypertensive crisis in children up to ≤ 12 years of age.