Labetalol Group Research Articles

A comparative study of IV labetalol with oral nifedipine in severe preeclampsia

Aims and Objectives: To compare the efficacy and safety of intravenous Labetalol over Nifedipine in severe preeclampsia patients and to study the effect of Labetalol on maternal and fetal outcome in severe preeclampsia patients. Methodology: This is a prospective comparative study in antenatal mother with sever preeclampsia done from June 2017 and May 2018. All the data were entered and analyzed using SPSS version 22. Results: Among 50 study patient population 25 patients received oral nifedipine (group A) and 25 patients received i.v. Labetalol (group B). Result shows that from1 hr to 6 hrs the mean systolic BP in the labetalol group was found to be lower than nifedipine group and mean diastolic BP from 1 hr to 6 hrs in the labetalol group was found to be lower than nifedipine group. 32% of antenatal mothers in the nifedipine group delivered before 36 weeks whereas in labetalol group only 4% of antenatal mothers delivered before 36 weeks. 32% of newborn, born to the mothers in the nifedipine group required NICU admission whereas in the labetalol group it was only 4%. Conclusion: Thus, concluded that both the drugs were found to be safe and effective in the reduction of blood pressure. But intravenous labetalol showed a rapid reduction of blood pressure at a shorter duration with a minimal dosage compared to oral nifedipine along with a lower incidence of preterm and lesser admission to NICU among the antenatal mothers treated with labetalol compared to oral nifedipine.

Clinical profile of pregnant women with pregnancy induced hypertension

Multisystem disorders of unknown aetiology characterized by development of HTN to the extent of 140/90 mm Hg or more with Proteinuria after 20thwk of pregnancy in a previously normotensive and non proteinuric patient. May appear before 20wks in cases of hydatidiform mole, acute polyhydramnios and multiple pregnancies. BP≥ 140/90 mm Hg before pregnancy or diagnosed before 20 weeks gestation not attributable to gestational trophoblastic disease (OR) Hypertension first diagnosed after 20 weeks gestations and persistent after 12 weeks postpartum. In chronic HTN, the foetus is more prone for growth restriction, preterm delivery, and death of foetus. 50% of the cases belong to The Labetalol Group, while the other 50% comprise The Nifedipine Group, selected randomly. Each group comprised a total of 62 cases, 50 of them are Mild PIH cases while the other 12 cases are the cases of Severe Hypertension, Imminent Eclampsia, Eclampsia, Placental Abruption etc. Most of the cases of Labetalol Group progressed up to term, of which one case crossed the EDD. This woman was discharged at her request and she reported to the hospital only after crossing the EDD. As many as 69.35% (43 cases) delivered vaginally in Labetalol Group, whereas the Caesarean section rate for Nifedipine group is about 48.39%. Emergency Caesarean section rate was 25.80% in Labetalol group where as it was 37.10% in the Nifedipine Group

Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial

Objective:To compare oral Nifidepine and IV labetalol in terms of rapidity of BP control in severe preeclampsia.Methods:All patients coming to Services Hospital from March 2017 to February 2019 with diagnosis of severe preeclampsia ≥ 24 weeks gestation were randomized to either receive Nifidepine or Labetalol. Primary outcome measure was time taken to control BP and number of doses required. Secondary outcome measures were side effects of drugs, APGAR score, NICU admission and perinatal mortality.Results:Two hundred four patients were included in trial with 102 patients in each group. Labetalol took 22.6± 13.5minutes and Nifidepine took 22.09± 11.7 minutes to achieve target BP (p>0.05). Labetalol required 2.3± 1.58 doses and Nifidepine 2.2± 1.58 doses to control BP ( p>0.05). No maternal side effects were seen in 86 (84.31%) and 92(90.19%) patients in both groups (p>0.05). Mean gestational age at birth was 34.8 ±2.73weeks in Labetalol and 35.2±2.48 weeks in Nifidepine group (p>0.05). In labetalol group, 43 (42.15%) babies had APGAR Score < 7/10 and 23(22.54%) babies required admission to NICU while in Nifidepine group 42 (41.17%) babies had Apgar score < 7/10 & 30(29.4%) babies were admitted to NICU(p>0.05). There were 21(20.5%) perinatal deaths in labetalol Group-And 19(18.6%) in Nifidepine group (p>0.05)Conclusion:Oral Nifidepine and IV labetalol are equally efficacious in controlling BP in patients with severe pre eclampsia without any significant side effects.

Labetalol as an Alternative to Esmolol and Fentanyl for Maintaining Hemodynamic Stability during Laparoscopic Surgery: Comparative Effects on Recovery Profiles and a Literature Review

β-blockers like labetalol and esmolol have been successfully used for controlling acute autonomic responses during surgery. Objective: To compare the intraoperative use of labetalol and esmolol to fentanyl for maintaining hemodynamic stability during laparoscopic surgery and assess their effects on recovery profiles. Methods: 75 patients were randomly assigned to receive one of three different adjunctive treatments regimens. Immediately prior to induction of anesthesia, 1 mL of the unlabeled study medication (fentanyl [50μg/mL], or labetalol [5mg/mL], or esmolol [10 mg/mL]) was administered. A second 1mL dose of the same study medication was administered immediately before skin incision and subsequently as needed [‘rescue’] during the surgical procedure to maintain heart rate (HR) and mean arterial pressure within 15% of the pre-induction baseline values. Results: The labetalol and esmolol groups had similar intraoperative HR and MAP values compared to the fentanyl group (p=0.4 and p=0.1 respectively). Fewer patients in the labetalol group required intraoperative rescue medications compared to the esmolol and fentanyl groups (p=0.0003). There were no significant differences in the requirement for parenteral opioid medication in the early postoperative period among the three groups. Of the post-discharge recovery outcomes studied, only incidence of ‘low appetite’ differed among the three groups, favoring the labetalol group over the fentanyl group (p=0.05). Labetalol was also less costly than both esmolol and fentanyl. Conclusion: Labetalol and esmolol were found to be comparable to fentanyl for maintaining hemodynamic stability during laparoscopic surgery. However, labetalol required less intraoperative rescue medication and had less adverse effect on appetite in the post-discharge period.

Comparative evaluation of efficacy and safety of methyldopa and labetalol in pregnancy-induced hypertension: A meta-analysis

Introduction: Methyldopa and labetalol are the drugs that frequently used for the management of pregnancy-induced hypertension. But fewer data available for the efficacy and safety of their use. So, here we are doing a systemic review for the safety and efficacy of methyldopa in comparison to labetalol. Objectives: Assessment of efficacy and safety of methyldopa versus labetalol in pregnancy-induced hypertension. Method: A total of 10 randomized controlled trials (RCTs) following PRISMA guidelines (2015) and have included pregnant women who developed hypertension after the 20th week of gestation and receiving methyldopa (100–400 mg/day) or labetalol (250–1000 mg/day). All RCTs with changes in mean arterial pressure (MAP) before and after drug administration was collected. The adverse effects of the respective drugs were also noted. RevMan 5.3 software was used for the calculation of standardized mean difference (SMD). P value less than 0.05 will be considered significant. Result: Data of 1,200 patients were included in our study. Both the drug decreases MAP statistically significantly. In the labetalol group, P value was statistically significant (random effect model P Conclusions: Labetalol is more efficacious and safer as compared to methyldopa.

Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial

SummaryBackgroundHypertension is the most common medical disorder in pregnancy, complicating one in ten pregnancies. Treatment of severely increased blood pressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low-resource environments. We therefore aimed to compare the efficacy and safety of three oral drugs, labetalol, nifedipine retard, and methyldopa for the management of severe hypertension in pregnancy.MethodsIn this multicentre, parallel-group, open-label, randomised controlled trial, we compared these oral antihypertensives in two public hospitals in Nagpur, India. Pregnant women were eligible for the trial if they were aged at least 18 years; they were pregnant with fetuses that had reached a gestational age of at least 28 weeks; they required pharmacological blood pressure control for severe hypertension (systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg); and were able to swallow oral medications. Women were randomly assigned to receive 10 mg oral nifedipine, 200 mg oral labetalol (hourly, in both of which the dose could be escalated if hypertension was maintained), or 1000 mg methyldopa (a single dose, without dose escalation). Masking of participants, study investigators, and care providers to group allocation was not possible because of different escalation protocols in the study groups. The primary outcome was blood pressure control (defined as 120–150 mm Hg systolic blood pressure and 70–100 mm Hg diastolic blood pressure) within 6 h with no adverse outcomes. This study is registered with ClinicalTrials.gov, number NCT01912677, and the Clinical Trial Registry, India, number ctri/2013/08/003866.FindingsBetween April 1, 2015, and Aug 21, 2017, we screened 2307 women for their inclusion in the study. We excluded 1413 (61%) women who were ineligible, declined to participate, had impending eclampsia, were in active labour, or had a combination of these factors. 11 (4%) women in the nifedipine group, ten (3%) women in the labetalol group, and 11 (4%) women in the methyldopa group were ineligible for treatment (because they had only one qualifying blood pressure measurement) or had treatment stopped (because of delivery or transfer elsewhere). 894 (39%) women were randomly assigned to a treatment group and were included in the intention-to-treat analysis: 298 (33%) women were assigned to receive nifedipine, 295 (33%) women were assigned to receive labetalol, and 301 (33%) women were assigned to receive methyldopa. The primary outcome was significantly more common in women in the nifedipine group than in those in the methyldopa group (249 [84%] women vs 230 [76%] women; p=0·03). However, the primary outcome did not differ between the nifedipine and labetalol groups (249 [84%] women vs 228 [77%] women; p=0·05) or the labetalol and methyldopa groups (p=0·80). Seven serious adverse events (1% of births) were reported during the study: one (<1%) woman in the labetalol group had an intrapartum seizure and six (1%) neonates (one [<1%] neonate in the nifedipine group, two [1%] neonates in the labetalol group, and three [1%] neonates in the methyldopa group) were stillborn. No birth had more than one adverse event.InterpretationAll oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs—methyldopa, nifedipine, and labetalol—are viable initial options for treating severe hypertension in low-resource settings.FundingPREEMPT (University of British Columbia, Vancouver, BC, Canada; grantee of Bill & Melinda Gates Foundation).

COMPARISON OF ESMOLOL, LABETALOL AND LIGNOCAINE FOR ATTENUATION OF SYMPATHOMIMETIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

INTRODUCTION: In some individual’s suffering from hypertension, coronary artery disease, cerebrovascular disease, myocardial infarction and thyrotoxicosis, these hemodynamic stress responses can turn into life-threatening conditions like left ventricular failure, myocardial ischemia, cerebral hemorrhage, and ruptured cerebral aneurysm. Different drugs like lidocaine, vasodilator agents inhibiting sympathoadrenal response, α-and β-adrenergic blockers, and opioids can be administered prior to tracheal intubation to prevent hemodynamic responses. But higher dose of lignocaine may lead to hypotension, bradycardia, and hypoxia in patients. Due to various effect of these drugs on hemodynamic changes in patients this study was carried out to evaluate the effects of IV esmolol, lignocaine, and labetalol for attenuation of hemodynamic response to laryngoscopy and intubation.&#x0D; MATERIAL AND METHODS: A total of 90 consecutive patients were included in the study and were grouped in to, lignocaine group, labetalol and esmolol group containing 30 patients each. Age group 21–65 years of either sex or American Society of Anesthesiologists (ASA) Grade I or II scheduled for various general surgical procedures under endotracheal anesthesia were included in this study. Patients excluded were pregnant and lactating women, morbid obesity, and hypertension.&#x0D; RESULTS: Mean Age in Group 1, group2 and group 3 was 40.38 ± 7.25, 43.8 ± 9.24 and 42.56 ± 8.71 respectively while weight was 62.41 ± 7.32, 63.63 ± 8.11 and 60.74 ± 6.92 respectively. There were 17 male and 13 female in group 1, 19 male and 11 female in group 2 and 16 male and 14 female in group 3. Attenuation of blood pressure was more in labetalol group. Reduction of heart rate in labetalol group was significant. It is seen that Labetalol was more effective at attenuation of diastolic blood pressure among all drugs. Mean arterial pressure was not much reduced lignocaine and esmolol group as compared to labetalol.&#x0D; CONCLUSION: Haemodynamic alterations are usually observed during laryngoscopy and endotracheal intubation. In our study it was found that as labetalol is a safe and effective drug, for attenuation of sympathomimetic response.

Comparing the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy

This study was conducted to compare the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy. In this randomized clinical trial study 70 patients undergoing microlaryngoscopy were involved. The patients were randomly assigned into two groups. Patients in dexmedetomidine group received 0.5μg/kg of dexmedetomidine diluted in 100ml of saline solution and the patients in the second group received 0.25mg/kg of labetalol before anesthesia induction. At the beginning of the surgery, dexmedetomidine was infused at the dose of 0.4μg/kg/h in the dexmedetomidine group, and labetalol at the dose of 1.8mg/kg/h in the labetalol group. Patients' systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate at different times and anesthesia and surgery duration, recovery time and dose of prescribed propofol were recorded and compared between two groups. There was a significant difference in mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate between two groups at different times (p value < 0.05). The results of this study indicated that dexmedetomidine had higher efficacy, compared to labetalol, in reducing diastolic blood pressure, systolic blood pressure, heart rate, and mean arterial blood pressure following microlaryngoscopy.

A Comparison of Labetalol and Nitroglycerin for The Management of Intraoperative Hypertension in Ambulatory Surgical Patients Who Underwent Cataract Surgery

Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery. Methods: A total of 80 hypertensive patients (systolic blood pressure&gt; 200 mmHg or diastolic blood pressure&gt;100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg. Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P&lt;0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p&lt;0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p&lt;0.05). Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia.

IV labetalol and oral nifedipine in acute control of severe hypertension in pregnancy–A randomized controlled trial

ObjectiveTo compare the efficacy of intravenous labetalol with oral nifedipine in the treatment of severe hypertension in pregnancy with blood pressure ≥160/110 mm Hg. Design, setting and participantsWe conducted a parallel double-blinded randomized controlled trial between December 2014 to December 2016 in 120 antenatal women of gestational age >28 weeks, admitted with severe hypertension of blood pressure ≥160/110 mm Hg to maternity ward at a tertiary hospital.The labetalol group received 20 mg initially followed by escalating doses of 40 mg, 80 mg, 80 mg and 80 mg (5 doses) every 15 min to a maximum of 300 mg. Nifedipine group received 10 mg initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg. Vital signs were recorded every 15 min.-The time taken and the number of doses required to achieve the target blood pressure (150/100 mmHg). Survival analysis was used to compare the efficacy of treatment regimens. ResultsSixty women were randomised to each group and none were lost to follow-up. None of the patients in nifedipine group required labetalol, whereas three patients in labetalol group achieved target BP only after receiving nifedipine was administered after the maximum dose of labetalol.The mean time taken to achieve the target blood pressure in the labetalol group was higher (36.75 min) than in the nifedipine group (27.25 min) [mean difference 9.5 min,p = 0.002]. Nifedipine group required significantly lower doses (1.82 ± 0.83) as compared to labetalol (2.45 ± 1.32) [p = 0.002]. Nifedipine was 1.8 times more likely to achieve target blood pressure (Hazard Ratio = 1.8). ConclusionsBoth intravenous Labetalol and oral Nifedipine were effective in controlling blood pressure. Nifedipine reduced BP more rapidly than Labetalol. Oral Nifedipine may be a better alternative because of its ease of oral administration and a flat dosing regimen.

COMPARISON OF ESMOLOL, LABETALOL AND LIGNOCAINE FOR ATTENUATION OF SYMPATHOMIMETIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

INTRODUCTION: In some individual’s suffering from hypertension, coronary artery disease, cerebrovascular disease, myocardial infarction and thyrotoxicosis, these hemodynamic stress responses can turn into life-threatening conditions like left ventricular failure, myocardial ischemia, cerebral hemorrhage, and ruptured cerebral aneurysm. Different drugs like lidocaine, vasodilator agents inhibiting sympathoadrenal response, α-and β-adrenergic blockers, and opioids can be administered prior to tracheal intubation to prevent hemodynamic responses. But higher dose of lignocaine may lead to hypotension, bradycardia, and hypoxia in patients. Due to various effect of these drugs on hemodynamic changes in patients this study was carried out to evaluate the effects of IV esmolol, lignocaine, and labetalol for attenuation of hemodynamic response to laryngoscopy and intubation.&#x0D; MATERIAL AND METHODS: A total of 90 consecutive patients were included in the study and were grouped in to, lignocaine group, labetalol and esmolol group containing 30 patients each. Age group 21–65 years of either sex or American Society of Anesthesiologists (ASA) Grade I or II scheduled for various general surgical procedures under endotracheal anesthesia were included in this study. Patients excluded were pregnant and lactating women, morbid obesity, and hypertension. RESULTS: Mean Age in Group 1, group2 and group 3 was 40.38 ± 7.25, 43.8 ± 9.24 and 42.56 ± 8.71 respectively while weight was 62.41 ± 7.32, 63.63 ± 8.11 and 60.74 ± 6.92 respectively. There were 17 male and 13 female in group 1, 19 male and 11 female in group 2 and 16 male and 14 female in group 3. Attenuation of blood pressure was more in labetalol group. Reduction of heart rate in labetalol group was significant. It is seen that Labetalol was more effective at attenuation of diastolic blood pressure among all drugs. Mean arterial pressure was not much reduced lignocaine and esmolol group as compared to labetalol.&#x0D; CONCLUSION: Haemodynamic alterations are usually observed during laryngoscopy and endotracheal intubation. In our study it was found that as labetalol is a safe and effective drug, for attenuation of sympathomimetic response.

Abstract WP331: Choice of Antihypertensive Agent Prior to Thrombolysis Has No Affect on Door-to-Needle Time: A Single Center Experience

Introduction: Treatment of acute ischemic stroke with intravenous thrombolysis (IVT) should be as rapid as possible. A subset of patients with acute ischemic stroke present with blood pressures above that considered safe for thrombolytic administration, and antihypertensive therapy is necessary. Guideline statements are ambivalent regarding which antihypertensive agent should be used to obtain a satisfactory blood pressure (BP &lt; 185/110 mmHg) prior to IVT. Hypothesis: DTN time will not differ amongst the antihypertensive agent groups. Methods: We reviewed data from consecutive patients at our institution treated with IVT from 01/2014 to 07/2018 and collected door-to-needle (DTN) time, antihypertensive agent (if used), and antihypertensive-to-needle (ATN) time. Patients were grouped by initial agent administered. An independent samples t-test was used to compare the labetalol and nicardipine group DTN and ATN times, as well as DTN times for patients receiving any antihypertensive agent with DTN times for those who did not. We performed a one-way ANOVA to compare DTN times across all groups (no agent, labetalol, nicardipine, hydralazine). Significance was defined as p &lt; 0.05 for all tests. Results: Analysis included 205 patients: 149 receiving no antihypertensive, 42 receiving labetalol, 12 receiving nicardipine, and 2 receiving hydralazine. Those not administered an antihypertensive prior to IVT had shorter DTN times (53.05 min versus 61.96 min, p = 0.039). Although not statistically significant, there was a trend towards longer DTN (64.76 min versus 51.33 min, p = 0.205) and ATN times (18.02 min versus 10.58 min, p = 0.171) in the labetalol group. There was not a difference in DTN time across all groups (F(3,205) = 2.213, p = 0.088), although labetalol trended towards higher times than those not administered any agent on post-hoc Tukey HSD test (p = 0.071). Conclusions: At our institution, patients requiring antihypertensive treatment did experience slower DTN times. Choice of antihypertensive agent did not affect DTN times, however there was a trend towards slower times with labetalol. This study is limited by relatively small sample size. Pooling data from multiple institutions could provide a more robust assessment and inform clinical practice.

Oral labetalol versus oral nifedipine for the management of postpartum hypertension a randomized control trial.

Objective:To compare the efficacy of oral Labetalol versus oral Nifedipine for the treatment of postpartum hypertension.Methods:A prospective randomized controlled trial with parallel assignment was conducted in the department of Obstetrics and Gynecology, Dow University of Health Sciences Karachi, Pakistan, 124 patients with post partum hypertension were selected and randomized into two groups with 62 patients receiving Labetalol and 62 receiving long acting nifedipine. Initial blood pressures were recorded, and the respective drug was administered. Dose adjustments were performed in the initial 24 hours. The outcome was measured in the form of drug efficacy by lowering of systolic blood pressure less than 140mm of Hg and diastolic less than 90mm of Hg up to 48 hours after starting treatment. Data was entered and analyzed through SPSS version 20.Results:Our study randomized 62 women to oral labetalol and 62 women to oral long acting nifedipine. The time required to achieve blood pressure control was 35.6±2.8 hours in labetalol group and 30.4±1.9 hours in nifedipine group (p=0.04).length of hospital stay, need of additional antihypertensive medications were same in both groups. Minor side effects were observed more in nifedipine group.Conclusion:We conclude that both oral labetalol and oral long acting nifedipine are effective and well tolerated interventions for the management of post-partum hypertension. However we found Nifidipine more effective in the management of postpartum hypertension.

Associations of polymorphisms of CYP2D6 and CYP2C9 with early onset severe pre-eclampsia and response to labetalol therapy.

Early onset preeclampsia (PPE) contributes to life-threatening maternal complications and fetal demise. Pharmacogenomics is a precision medicine, and metabolizing enzymes responsive to antihypertensive remains understudied. The aim of this study was to evaluate the associations of polymorphisms of cytochrome P450, family 2, subfamily D, polypeptide 6 (CYP2D6) and cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9) with PPE and the relationship among CYP2D6, CYP2C9 polymorphisms and response to labetalol therapy. Totally 105 gravidas diagnosed with PPE (case) and 103 healthy gravidas (control) were recruited between August 2013 and July 2016. Labetalol was given to control blood pressures (BP) with PPE. If labetalol administration alone did not exceed the mean dose and effectively controlled the BP, it would be considered to be valid (n = 75). Genotype and allele frequencies of CYP2C9 gene (rs1057910 and rs4918758) and CYP2D6 gene (rs1065852, rs28371725, rs35742686, and rs3892097) were analyzed by TaqMan PCR. Differences in the genotype and allele frequencies were compared between case-control groups, and the responsive and nonresponsive to labetalol in PPE. Out of six variants, only CC and CT genotypes of the CYP2D6 variants (rs28371725) in PPE were significantly higher than those in the control group [18.1% (19/105) vs 14.6% (15/103); 56.2% (59/105) vs 42.7% (44/103); χ2 = 6.707]. However, there were no differences in maternal age, diastolic pressure, BMI, BW, serum triglyceride, and creatinine were observed among women with CC, CT, or TT genotype of CYP2D6 gene rs28371725 in the experimental group (all P > 0.05). Compared with the gravidas with CT or TT genotype of CYP2D6 gene rs28371725, those with CC genotype had longer gestational age [(32.5 ± 2.1) vs (29.5 ± 1.8) and (29.8 ± 2.2)weeks] and higher plasma albumin [(27.2 ± 9.3) vs (20.3 ± 10.4) and (22.5 ± 7.4)g/L], but lower systolic pressure and 24h urine protein (LSD test, all P < 0.05). The G allele frequency in CYP2D6 gene rs1065852 nonresponsive to labetalol group was higher than that in responsive labetalol group [93.3% (56/60) vs 76.0% (114/150), χ2 = 8.351, P = 0.004]. The polymorphism of CYP2D6 gene rs28371725 may be associated with PPE, and the allele of G in CYP2D6 gene rs1065852 may be associated with the efficacy of labetalol in treatment of PPE.

Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow

The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120 mmHg (n = 14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100–120 mmHg (n = 17) were treated with SL nitroglycerin (0.3 mg) (‘NTG Group’) and those with baseline MAP<100 mmHg (n = 18) were not treated with antihypertensive drugs (untreated group). Forty-nine patients (18 female, mean age 65.3 ± 12.9 years) were serially imaged. Labetalol reduced MAP by 12.5 (5.7–17.7) mmHg, p = 0.0002. MAP remained stable in the NTG (6.0 (0.4–16, p = 0.3) mmHg and untreated groups (−0.3 (−2.3–7.0, p = 0.2) mmHg. The volume of total hypoperfused tissue (CBF<18 ml/100 g/min) did not increase after labetalol (−1.1 ((−6.5)–(−0.2)) ml, p = 0.1), NTG (0 ((−1.5)–4.5) ml, p = 0.72), or no treatment 0.25 ((−10.1)–4.5) ml, p = 0.87). Antihypertensive therapy, based on presenting BP, in acute stroke patients was not associated with an increased volume of total hypoperfused tissue.

Hypotensive effect of labetalol and dexmedetomidine blood loss and surgical conditions in functional endoscopic sinus surgery

Background: Excessive bleeding occurs from mucosal edges during functional endoscopic sinus surgery (FESS). This could decrease the visibility of the surgeon and increase the risk incidence of complications. The current study aimed to evaluate the effect of labetalol and dexmedetomidine on intraoperative blood loss and surgical conditions in ESS. Methods: A double-blind randomized clinical trial was conducted on 100 candidates for FESS that randomly were assigned by block randomization method in two groups including labetalol or dexmedetomidine. Heart rate (HR), mean arterial blood pressure, and the percent of arterial oxygen saturation were measured after induction and during the hypotension. These items were recorded till the end of the surgery. A blinded surgeon was assessed the bleeding of operation field. Data were analyzed using t-test, Chi-square, and analysis of variance for repeated measures. Results: The mean time of surgery was not statistically significant between two groups (104.65 ± 7.38 vs. 105.12 ± 7.33). The mean of HR was higher in dexmedetomidine group in all times after induction (P Conclusion: Bleeding score, extubation, and recovery time in labetalol group was lower than dexmedetomidine group. Moreover, patients in labetalol group have had higher recovery score and lower bleeding. Therefore, labetalol could reduce the bleeding during FESS and improved the visualization of the operation field and was superior to dexmedetomidine in concern to lower bleeding and extubation and recovery time.

Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial.

BackgroundUncontrolled bleeding during surgery is one of the main predisposing factors for failure of the surgeon and complications following rhinoplasty. The current study aimed at comparing the effects of nitroglycerine and labetalol on the induction of controlled hypotension and bleeding volume during septorhinoplasty.MethodsThe current randomized, controlled, clinical trial enrolled 60 patients candidate for septorhinoplasty at Firoozgar hospital in Tehran, Iran, in 2 equal groups receiving either 0.1 to 1 mcg/kg/minute nitroglycerine or 2 to 4 mg/minute labetalol to achieve a mean arterial blood pressure of about 60 to 65 mmHg. In case the targeted blood pressure was not achieved, isoflurane was added. Degree of bleeding was evaluated by the volume of suctioned blood and the blood remaining in surgical gauzes. Additionally, the surgeon's satisfaction with the surgical field was evaluated by a scoring system. The collected data were, then, compared between the study groups by the statistical methods.ResultsBased on the current study findings, systolic (P < 0.001), diastolic (P = 0.002), and the mean arterial blood pressures (P < 0.001) were significantly lower in the nitroglycerine group. Ninety percent of the patients in the labetalol group received isoflurane to achieve the targeted blood pressure defined as controlled hypotension. There was no significant difference between the groups regarding the volume of bleeding (P = 0.75); however, the surgeons were more satisfied with nitroglycerine than labetalol (P < 0.001).ConclusionsIt was concluded that nitroglycerine had a better effect, in comparison to labetalol, on inducing the controlled hypotension in septorhinoplasty.

A Comparative Study of Intravenous Esmolol, Labetalol and Lignocaine in Low Doses for Attenuation of Sympathomimetic Responses to Laryngoscopy and Endotracheal Intubation.

Background:Direct layngoscopy and endotracheal intubation is a noxious stimuli and induces sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients. Esmolol, Labetalol and Lignocaine attenuate these responses but are associated with side effects of bradycardia, hypotension etc. In lower doses, chances of these side effects are comparatively low. So we designed this prospective clinical trial to assess the efficacy of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to endotracheal intubation.Materials and Methods:Seventy-five consenting patients of ASA physical status I or II of age range 20 to 60 years, scheduled for different general surgical procedures were randomly assigned to one of the three groups; group ES, group LB and group LG. Participants of group ES, group LB and group LG was given esmolol HCL 0.5 mg/Kg, labetalol HCL 0.25 mg/kg and lignocaine HCL 1 mg/Kg body weight respectively. Outcome variables were HR, SBP, DBP, MAP and RPP. These variables were recorded just after intubation and thereafter at 1,3,5, 7 and 10 minutes of intubation.Results:There was no statistically significant difference regarding the demographic characteristics of the groups. Heart rate and systolic blood pressure was lower throughout the study period in labetalol group. But the values of study parameters were always higher than the baseline in esmolol and lignocaine group. Values of mean arterial pressure was slightly higher in labetalol group but it was much higher in two other groups throughout the study period. Diastolic blood pressure was higher in all the groups. Values of rate pressure product was higher during intubation and at 1minute after intubation in labetalol group but thereafter it was always lower than baseline values.Conclusion:Labetalol 0.25 mg Kg-1 is an effective and safe drug to be used for attenuation of sympathomimetic responses to endotracheal intubation. Esmolol 0.5 mg Kg-1 and lignocaine 1 mg Kg-1 are also effective to some extent and are safe.

Comparing the Effect of Labetalol versus Morphine on Controlling Blood Pressure and Pulse Rate during Emergence from Anesthesia after Craniotomy.

Background:Emergence from anesthesia is associated with sympathetic stimulation, increase in pulse and blood pressure. There are different methods, but the most appropriate method should be selected regarding the differences in nationalities. This study aimed to compare the efficacy of morphine and labetalol in controlling blood pressure and pulse during emergence from anesthesia in brain tumors craniotomy.Materials and Methods:This study was conducted at Al-Zahra Hospital of Isfahan - Iran on 60 patients suffering from brain tumor candidated for craniotomy and randomly classified into two groups of 30. One group received labetalol with dose of 10 mg over 10 min from 45 min before finishing dressing and then 0.75 mg/min until 35 min later; another group received morphine in bolus dose of 0.1 mg/kg during 2–3 min. Blood pressure and pulse were measured every 10 min over 40 min. After operation, they were measured every 5 min over 15 min.Results:The morphine group had higher systolic (133.3 ± 18.8) and diastolic blood pressure (87.1 ± 13.6) (P = 0.021 and 0.028, respectively) at extubation and during 45 min before dressing, the diastolic blood pressure was significantly higher in compares with labetalol (75.3 ± 10.5) (P < 0.05). And extubation time was significantly shorter in labetalol group (7.7 ± 0.84) (P < 0.001). Pulse had no significant difference in both groups. In labetalol group, blood pressure and pulse fluctuations were more stable.Conclusion:Administration of labetalol 45 min before finishing dressing can significantly control blood pressure during emergence from anesthesia and also shorten the time of extubation during emergence in patients undergoing craniotomy.

Comparison of Hydralazine and Labetalol to lower severe hypertension in pregnancy.

Objective:To compare the intravenous Labetalol versus intravenous hydralazine in patients having severe Pregnancy induced hypertension (PIH) and pre eclampsia (PE) in pregnancy.Methods:Seventy eight women admitted in the Department of Gynecology and Obstetrics, Civil Hospital Karachi, having severe PIH/PE and fulfilling the inclusion criteria were included in the study. Random selection of patients was performed using sealed opaqe envelop for administration of either intravenous noted (IV) Labetalol or Hydrallazine. The mean fall in the MAP in each group was noted. This data was analyzed by applying SPSS version 13. The study was conducted from November 2012 to April 2013.Results:The mean (±SD) age of the labetalol group was 27.46 (±5.28) years while that in the hydralazine group was 26.28 (±5.17) years. The mean fall in MAP observed in the labetalol group was 29.10 ± 7.21 mmHg and that in the hydralazine group was 25.05 ± 10.15 mmHg which was statistically significant with the p value being 0.046.Conclusion:Intra Venous labetalol lowered MAP more than hydralazine, when administered to pregnant females with severe Pregnancy induced hypertension and pre eclampsia in pregnancy.