Labetalol for the control of elevated blood pressure following coronary artery bypass grafting

Sladen, Robert N.; Klamerus, Karen J.; Swafford, Melba W.G.; Prough, Donald S.; Mann, Henry J.; Leslie, John B.; Goldberg, Jay; Levitsky, Sidney; Molina, J. Ernesto; Mills, Stephen A.

doi:10.1016/0888-6296(90)90240-g

Cited by 22 publications

(5 citation statements)

References 16 publications

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“…Intravenous labetalol successfully controlled post-CABG hypertension in 55 of 65 patients (85%); of these, 46 responded to 35 mg or less. Sladen concluded that IV labetalol appears to be a safe, effective agent in controlling post-CABG hypertension, with the added potential benefit of enhanced myocardial oxygen balance [29]. However, Sladen et al, study differs from our study in various aspects, regarding the patient group, the method and the timing of labetalol administration; however, both studies share the same conclusion of labetalol safety and efficacy in managing postoperative hypertension.…”

Section: * Denotes Statistically Significant Difference Between the 3contrasting

confidence: 40%

Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

Radwan

Fadel

Fahmy

et al. 2016

Egyptian Journal of Anaesthesia

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Background: Acute hypertension is a common accompaniment during emergence from anesthesia especially in intracranial neurosurgical procedures and may be associated with the development of intracranial hematoma. Although various drugs have been evaluated, management of emergence hypertension in this subset of patients continues to be a challenge for anesthesiologists. Methodology: Seventy-five patients ASA (I-II) scheduled for supratentorial craniotomy under general anesthesia were randomly allocated to one of three groups at the time of dural closure: Group ''dex" received dexmedetomidine infusion in a rate of 1 lg/kg/hr, Group ''labetalol" received labetalol infusion in a rate of 0.5 mg/kg/hr, and Group ''control" a control group where patients received saline infusion at the same rate of dexmedetomidine and labetalol. Hypertensive episodes were managed with nitroglycerin at a dose starting from 1 lg/kg/min if systolic blood pressure exceeded 25% of its preinduction value. Hemodynamic parameters as well as the number of patients, the total dose of nitroglycerin required in each group and the time to extubation were recorded. Results: Dexmedetomidine and labetalol had a significant effect in reducing SBP, MAP, DBP, HR during emergence from anesthesia, with more reduction of the SBP, MAP and DBP in the dexmedetomidine group and of the HR in the labetalol group in comparison with the other two groups. The number of patients needing nitroglycerin was 8 representing 32% of patients in dexmedetomidine group, 5 representing 20% of patients in labetalol group and 22 representing 88% of patients in control group (P value = 0.032). Time to emergence from anesthesia was comparable in the three groups. Conclusion: Both dexmedetomidine and labetalol had favorable effects on hemodynamics at time of emergence from anesthesia in comparison with control group without prolongation of the time of extubation.

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Section: * Denotes Statistically Significant Difference Between the 3contrasting

confidence: 40%

Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

Radwan

Fadel

Fahmy

et al. 2016

Egyptian Journal of Anaesthesia

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“…28 Five factors were established as causes: 1) hypertension (especially if poorly controlled); 2) clinical conditions (diabetes, vascular disease, advanced age, kidney disease, pain, anxiety, hypothermia, post-anesthesia tremors, excitement, hypoxia, hypercapnia, antihypertensive withdrawal, hypervolemia, hypovolemia, myocardial ischemia, drug interactions, increased intracranial pressure, pulmonary embolism, vasopressor therapy, bronchodilators); 3) operative factors (surgical technique, duration of the procedure); 4) surgical procedures (vascular, cardiothoracic, neurosurgery, head and neck); and 5) anesthetic factors (pancuronium inhibitors, acetylcholinesterase, opioid antagonists, placement of the endotracheal tube, bladder distension). 5,29,30…”

Section: Pathophysiologymentioning

confidence: 99%

Acute Arterial Hypertension in Patients undergoing Neurosurgery

et al. 2016

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Introduction Between 20-50% of neurosurgical patients may develop early perioperative complications, and 25% have more than one clinical complication. The most commons are high blood pressure (25%) and cardiovascular events (7%). Intraoperative hypertension is characterized by an increase of 20% in basal blood pressure. Objectives The aim of this paper is to review and discuss the pathophysiology, diagnosis and treatment of perioperative hypertension in patients undergoing neurosurgery, and to propose one table with therapeutic options. Methods A review using Scielo, PubMed, Ebsco and Artmed databases with inclusion and exclusion criteria. Articles published from 1957 to 2015 were selected. Discussion Five factors were established as causes: arterial hypertension, clinical conditions, surgical procedures, and operative and anesthetic factors. Specific causes preoperative, intraoperative and posoperative. The pathophysiology may have some relationship with catecholamines and sympathetic nervous system stimulation. Conclusion Perioperative hypertension in neurosurgery may have many causes, some of them recognizable and preventable. This increased pressure may be associated with intracranial hematomas in some cases. The recognition and treatment of this disease can be helpful in the management of the postoperative period.

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“…Additionally, the non-selective beta adrenergic receptor agonist dobutamine has been shown to increase systemic arterial systolic and pulse pressures with a decrease in diastolic pressure, consistent with its positive inotropic and systemic arteriolar vasodilator functions (Akosah et al 1999). Finally, the beta adrenergic receptor antagonist labetalol, although it has mixed properties, has been shown to preferentially reduce systemic arterial systolic and pulse pressures in the documented absence of any effect on systemic vascular resistance (Sladen et al 1990). These findings are consistent with the results of clinical trials of the beta adrenergic receptor antagonists propranolol and atenolol in the prevention of ascending aortic dilatation in Marfan's syndrome (Salim et al 1994;Shores et al 1994), which were designed to test the hypothesis (Halpern et al 1971) that diminishing the aortic pulse amplitude and systolic ejection dp dt would have beneficial effects on aortic wall remodeling.…”

Section: Hemodynamic Factorsmentioning

confidence: 95%

Towards an understanding of the mechanics underlying aortic dissection

Rajagopal

Bridges

Rajagopal

2007

Biomech Model Mechanobiol

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Acute aortic dissection and associated aortic catastrophes are among the most devastating forms of cardiovascular disease, with a remarkably high morbidity and mortality despite current medical and surgical treatment. The mechanics underlying aortic dissection are incompletely understood, and a further understanding of the relevant fluid and solid mechanics may yield not only a better appreciation of its pathogenesis, but also the development of improved diagnostic and therapeutic strategies. After illustrating some of the inadequacies with respect to the extant work on the mechanics of aortic dissection, we alternatively postulate that the clinical hemodynamic disturbances that render the aorta susceptible to the initiation of dissection are principally elevated maximum systolic and mean aortic blood pressure, whereas the hemodynamic disturbances that facilitate propagation of dissection are principally elevated pulse pressure and heart rate. Furthermore, abnormal aortic mechanical properties and/or geometry are requisite for dissection to occur. Specifically, we propose that the degree of anisotropy will directly influence the probability of future aortic dissection. Imaging of the aorta may provide information regarding aortic anisotropy and geometry, and in combination with a hemodynamic risk assessment, has the potential to be able to prospectively identify patients at high risk for future aortic dissection thereby facilitating prophylactic intervention. The aim of the paper is to identify the main mechanical issues that have a bearing on aortic dissection, and to suggest an appropriate mathematical model for describing the problem.

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Labetalol for the control of elevated blood pressure following coronary artery bypass grafting

Cited by 22 publications

References 16 publications

Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

Acute Arterial Hypertension in Patients undergoing Neurosurgery

Towards an understanding of the mechanics underlying aortic dissection

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