1. CO AUTHORS PROF. DR.I.CHANDRASEKARAN MDDA PROF. DR S.P.MEENAKSHISUNDARAM MDDA ASST PROF. DR.G.VIJAYA MD AUTHOR DR.H.VIJAYALAKSHMI MD PG INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE

2. INTRODUCTION  LARNGOSCOPY AND INTUBATION LEAD TO REFLEX CHANGES IN THE CARDIOVASCULAR SYSTEM  INCREASE IN BLOOD PRESSURE BY 40-50%, 20 % INCREASE IN HEART RATE  MAY LEAD TO CONSEQUENCES LIKE MYOCARDIAL ISCHEMIA,CEREBRO VASCULAR ACCIDENTS, PULMONARY EDEMA  HENCE STRESS ATTENUATION IS NEEDED TO BLUNT THESE RESPONSES

3. AIM  TO STUDY THE EFFECT OF LABETALOL ON STRESS ATTENUATION DURING LARYNGOSCOPY IN PREECLAMPTIC PATIENTS COMING FOR LOWER SEGMENT CAESAREAN SECTION

4. METHOD  ETHICAL COMMITTEE APPROVAL  INFORMED WRITTEN CONSENT  OBSERVATIONAL STUDY  INCLUSION CRITERIA  30 PREECLAMPTIC PATIENTS COMING FOR LOWER SEGMENT CAESAREAN SECTION  AGE- 20-35 YRS  WEIGHT 50-70 KGS

5. EXCLUSION CRITERIA  EVIDENCE OF ANTICIPATED DIFFICULT AIRWAY  BRONCHIAL ASTHMA  HEART BLOCK  DRUG ALLERGY

6. MONITORS  PULSEOXIMETRY  NON INVASIVE BLOOD PRESSURE  CAPNOGRAPHY

7. PROCEDURE  PATIENT POSITIONED SUPINE WITH LEFT UTERINE DISPLACEMENT  PREMEDICATION  INJ.GLYCOPYRROLATE O.2MG  INJ.RANITIDINE 50 MG  INJ.METOCLOPROMIDE 10 MG  INJ.LABETALOL 20MG SLOW IV 5MTS BEFORE LARYNGOSCOPY

8.  INDUCED WITH INJ.THIOPENTONE 5MG/KG, SUXA 1.5MG/KG  INTUBATED AND MAINTAINED WITH O 2,N 2 O  INJ.FENTANYL,ATRACURIUM USED IN TITRATED DOSES  REVERSED WITH INJ.NEOSTIGMINE 40µ/KG, GLYCOPYRROLATE 10µ/KG  AFTER ADEQUATE ATTEMPTS PATIENTS WERE REVERSED AND EXTUBATED

9. HEMODYNAMIC VARIABLES MEASURED  PULSE RATE  SYSTOLIC BLOOD PERESSURE  DIASTOLIC BLOOD PRESSURE  OXYGEN SATURATION PREOP, AT 1,3,5,10,20,30,60,120,180 MTS  APGAR SCORE

10. HEART RATE HEARTRATEHEARTRATE Time in minutes

11. BPmmhgBPmmhg SYSTOLIC BP

12. DIASTOLIC BP BPmmhgBPmmhg Time in minutes

13. SYSTOLIC & DIASTOLIC BP BPmmhgBPmmhg Time in minutes

14. APGAR SCORE  1 MINUTE – 7-8/10  5 MINUTES- 8-10/10

15. OBSERVATION  LABETALOL REDUCES HEART RATE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE 10-15 % FROM BASELINE  BLOOD PRESSURE LOWERING EFFECT IS MAXIMUM 5-15 AFTER ADMINISTRATION OF DRUG

16. LABETALOL  α,β BLOCKER  RATIO OF β : α 3:1 ORAL  RATIO OF β : α 7:1 IV  HALFLIFE 4-6 HRS AFTER IV, 6 -8 HOURS AFTER ORAL  ONSET IN 5 MTS, PEAK 5 – 15 MINUTES

17.  REDUCES SVR, REFLEX TACHYCARDIA PRODUCED BY VASODILATATION IS ATTENUATED BY BETA BLOCKADE  LIPID SOLUBLE,50% PROTEIN BOUND  F/M RATIO -0.2- 0.8  NO REBOUND HYPERTENSIO N

18.  IT CROSSES HUMAN PLACENTA TO PRODUCE CORD SERUM CONCENTRATION AVERAGING 40-60% OF PEAK MATERNAL LEVELS  LOW PLACENTAL TRANSFER IS DUE TO HIGH DEGREE OF IONISATION AT PHYSIOLOGICAL PH

19. SUMMARY  LABETALOL MINIMISES CARDIOVASCULAR STRESS RESPOSE TO LARYNGOSCOPY AND IUTUBATION  REDUCES SYSTEMIC VASCULAR RESISTANCE WITHOUT REFLEX TACHYCARDIA  LOW PLACENTAL TRANSFER

20.  IT DOES NOT CHANGE UTEROPLACENTAL BLOOD FLOW DESPITE DROP IN BP DUE TO REDUCED PERIPHERAL VASCULAR RESISTANCE  REDUCES THE INCIDENCE OF HYALINE MEMBRANE DISEASE IN PREMATURE INFANTS BY INCREASING SURFACTANT PRODUCTION DUE TO ITS β2 AGONIST ACTIVITY

21. CONCLUSION  LABETALOL IS AN EFFECTIVE DRUG TO ATTENUATE THE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION IN PREECLAMPTIC PATIENTS

22. REFERENCES  SEVERE HYPERTENSION IN PREGNANCY – HYDRALAZINE OR LABETALOL A RANDOMISED CLINICAL TRIAL – EUROPEAN JOURNAL OF OBS AND GYN 128-2006  CHANGES IN MATERNAL MIDDLE CEREBRAL ARTERY BLOOD FLOW VELOCITY ASSOCIATED WITH GA IN SEVERE PREECLAMPSIA-ANAES ANALGESIA 88 1999

23.  FETAL OUTCOME IN A RANDOMISED DOUBLE BLINDED CONTROLLED STUDY OF LABETALOL VS PLACEBO IN PIH –BJOG VOL 96 2005  EFFECTIVE IN MANAGEMENT  NO APPARENT DISADVANTAGE FOR THE FETUS  LABETALOL VS METHYLDOPA IN THE TREATMENT OF PIH  INTERNATIONAL J OF OG VOL 49 1995  QUICKER AND MORE EFFICIENT AT BP CONTROL, BENEFICIAL EFFECT ON RENAL BLOOD FLOW AND FEWER SIDE EFFECTS

24. THANK YOU