Uso de labetalol frente a nifedipino en la preeclampsia / Use of labetalol vs nifedipine in preeclampsia

Fundamento: La preeclampsia es un estado de vasoconstricción generalizado asociado a la disfunción del epitelio vascular en vez de vasodilatación propia del embarazo, caracterizada por la hipertensión proteinuria a partir de la semana 20, acompañada a veces de edemas; asimismo constituye un peligro de salud para la madre y el feto. El tratamiento clínico tradicional utiliza fármacos antihipertensivos por vía oral, entre los que se mencionan el labetalol y nifedipino de liberación prolongada. Objetivo: Analizar la efectividad del labetalol y del nifedipino como tratamiento antihipertensivo relacionado con preeclampsia. Metodología: Se recurrió a fuentes de consulta encontradas en Google Scholar, Science Direct, SciELO, Pubmed, Medes y Elsevier. De 211 fuentes se seleccionaron 31 de acuerdo con criterios de inclusión y exclusión. Conclusiones: Por consenso se ha determinado que en la mayor parte de fuentes de consulta el nifedipino por vía oral es más efectivo que el labetalol en el tratamiento de la preeclampsia.

Background: Pre-eclampsia is a generalized vasoconstriction state associated with vascular epithelial dysfunction rather than the vasodilation characteristic of pregnancy, characterized by proteinuric hypertension from the 20th week of pregnancy, sometimes associated with edema; it also causes health risks to the mother and fetus. Traditional clinical treatment uses oral antihypertensive drugs, among these labetalol and extended-release nifedipine are included. Objective: To analyze the efficacy of labetalol and nifedipine as an antihypertensive treatment in pre-eclampsia. Methodology: Reference sources found in Google Scholar, Science Direct, SciELO, Pubmed, Medes and Elsevier were used. Out of 211 sources, 31 were selected according to inclusion and exclusion criteria. Conclusions: It has been determined by majority consensus that oral nifedipine is more effective than labetalol in pre-eclampsia treatment.

Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study

Rhabdomyolysis in a patient taking nebivolol

β Blockers such as propranolol and labetalol are known to induce toxic myopathy because of their partial β₂ adrenoceptor agonistic effect. Nebivolol has the highest β1 receptor affinity among β blockers, and it has never been reported to induce rhabdomyolysis until now. We report a patient who developed rhabdomyolysis after changing medication to nebivolol. A 75-year-old woman was admitted to our hospital because of generalized weakness originating 2 weeks before visiting. Approximately 1 month before her admission, her medication was changed from carvedilol 12.5 mg to nebivolol 5 mg. Over this time span, she had no other lifestyle changes causing rhabdomyolysis. Her blood chemistry and whole body bone scan indicated rhabdomyolysis. We considered newly prescribed nebivolol as a causal agent. She was prescribed carvedilol 12.5 mg, which she was previously taking, instead of nebivolol. She was treated by hydration and urine alkalization. She had fully recovered and was discharged.

Persistent perioperative tachycardia and hypertension diagnosed as thyroid storm induced by a hydatidiform mole: a case report / 대한마취과학회지

Thyroid storm is a critical complication of molar pregnancy. However, early diagnosis of it is difficult because it is a rare complication and usually presents nonspecific findings. In this case report, we present a woman with molar pregnancy who had persistent tachycardia and hypertension. She was diagnosed initially with preeclampsia and sepsis as complications of molar pregnancy. During dilation and curettage under general anesthesia with sevoflurane and remifentanil, tachycardia and hypertension remained even with continuous infusion of labetalol. The patient was subsequently diagnosed with thyroid storm associated with molar pregnancy. She was restored to a clinically euthyroid state 1 day after the operation, and her thyroid function test and beta-hCG values were normal 3 months later. The anesthesiologists should bear in mind the possibility of thyroid storm in patients with molar pregnancies who show persistent tachycardia and hypertension.

[Comparison between effects of intravenous labetalol and hydralazine on control of hypertension and maternal and neonatal outcomes in severe preeclamptic patients: a randomized clinical trial]

Severe preeclampsia and eclampsia are responsible for 25% of maternal mortality, especially in developing countries. Considering the importance of this complication, the present study aimed to compare between effects of labetalol and hydralazine on control of hypertension and the maternal and neonatal outcomes in severe preeclamptic patients. This clinical trial study was conducted on 190 severe preeclamptic patients classified into two groups [95 subjects in each group]. Two groups were randomly received hydralazine [5 mg intravenously, every 20 minutes, up to a maximum of five doses] or labetalol [at first 20 mg intravenously, and if not effective, 40, 80, 80, 80 mg respectively, every 20 minutes, up to a maximum of five doses]. In both groups, blood pressure and heart rate were recorded 20 minutes after drug administration. Blood pressure control, as well as the maternal and neonatal outcomes, compared between two groups. Maternal and neonatal outcomes were compared using chi-square, Fisher's exact, Mann-Whitney, and t tests. All significant differences were at p<0.05. Demographic characteristics and blood pressure control were similar in both groups, only five women in the hydralazine group and four women in labetalol group had persistent severe hypertension after maximum of five doses. Hypotension was not observed in both groups. Maternal tachycardia was similar in two groups. Others maternal and neonatal outcomes had no significant differences between two groups. According to the results of this study, the effect of labetalol and hydralazin is similar in the control of hypertension in severe preeclamptic patients and there isn't significant different in maternal and neonatal outcome in two groups

Intravenous labetalol versus oral nifedipine in the treatment of severe hypertension in pregnancy

To evaluate the efficacy of intravenous labetalol versus oral nifedipine in the treatment of severe hypertension with pregnancy. Prospective, non-randomized. Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Fifty pregnant patients with severe hypertension [blood pressure >/= 160/110 mmHg]. The patients were consecutively given either intravenous labetalol or oral nifedipine. The speed and adequacy of control of blood pressure was compared in both groups Both drugs were effective in the control of blood pressure, but nifedipine caused significant reduction of blood pressure in 20 minutes with a single dose i.e., with the first dose [p = 0.03]. The diastolic blood pressure reduction was also significant with nifedipine [15.1 +/- 6 Vs 8.3 +/- 2 mmHg] [p = 0.03]. Average time required was also less with nifedipine [24 +/- 8.2 Vs 44.21 +/- 26.31 minutes, p = 0.006]. Both drugs effectively controlled the blood pressure in severe hypertension in pregnancy. However, nifedipine faired better than labetalol in time taken, reduction of diastolic blood pressure and number of patients responding with first dose [i.e., in 20 minutes]

The effect of intravenous labetalol administration on hemodynamic responses during desflurane inhalation / 대한마취과학회지

BACKGROUND: Inspired concentrations of desflurane > or = 1 minimum alveolar anesthetic concentration (MAC) have been related to sympathetic stimulation such as hypertension and tachycardia. The current study examined whether labetalol, an alpha1 and beta-adrenergic antagonist would blunt these hemodynamic responses. METHODS: Fifty-four ASA physical status I patients, aged 20-60 years, were enrolled in this study. The patients were randomly divided into 2 groups. The breathing circuit was primed with an end-tidal desflurane concentration of 1.2 MAC in 6 L/min O2. Normal saline 5 ml or labetalol 0.3 mg/kg was injected into groups S and L respectively. After 5 minutes, anesthesia was induced with intravenous etomidate 0.2 mg/kg and vecuronium 0.1 mg/kg. Each patient inhaled desflurane through a tight fitting facemask. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and end-tidal concentration of desflurane (et-des) were measured at 5 minutes after saline or labetalol injection (baseline) and every 1 minute for 5 minutes after desflurane inhalation and for 2 minutes after intubation. RESULTS: In the saline injection group (group S), desflurane inhalation increased heart rate and blood pressure, while labetalol 0.3 mg/kg attenuated the heart rate and blood pressure increase in group L. After tracheal intubation, heart rate and blood pressure were significantly lower in group L than in group S. CONCLUSIONS: These results demonstrate that administration of intravenous labetalol is effective in attenuating tracheal intubation and desflurane-induced hemodynamic responses.

The relationship of preoperative N-terminal pro-BNP and the amount of hemodynamic drugs used during noncardiac surgery

BACKGROUND: BNP and NT-proBNP are very useful predictor of perioperative cardiac events. The authors therefore performed a retrospective study about the relationship between NT-proBNP and intraoperative hemodynamic stability. METHODS: The authors reviewed the chart of 126 patients which were consulted to cardiologists for preoperative cardiac evaluation from 2005 through 2007. All patients were divided into two groups; N-group (NT-proBNP or = 300 pg/ml, n = 60). The kinds of hemodynamic drugs and dosage and infusion time were calculated. Total amounts of hemodynamic drugs are scored by two methods. Infusion drugs were scored 30 points, bolus drugs (esmolol 30 mg, labetalol 10 mg, phenylephrine 50microg, ephedrine 10 mg, atropine 0.25 mg, nicardipine 0.5 mg) and preclusive nitroglycerin infusion were scored 5 points. Drug score is total sum of all scores. We compared the drug score of two groups. In addition, bivariate and partial correlation analysis were performed for the correlation of drug score. RESULTS: H-group showed a high (P = 0.029) drug score (17.68 +/- 21.78) more than N-group (10.13 +/- 15.79). H-group showed a low (P = 0.000) ejection fraction (51.69 +/- 12.90%) more than N-group (61.80 +/- 7.84%). But, only age (R: 0.234, P: 0.023) and ejection fraction (R: -0.222, P: 0.032) were correlated with drug score by partial correlation analysis. CONCLUSIONS: Patients with preoperative high NT-proBNP had decreased systolic function and demanded more hemodynamic drugs during noncardiac surgery. But, NT-proBNP was not correlated with drug score in itself.

Infarto agudo do miocárdio relacionado ao uso de cocaína / Acute myocardial infarction related to cocaine use

Esta revisão discute o estado atual da fisiopatologia e do tratamento do infarto agudo do miocárdio relacionado ao uso de cocaína. O abuso de drogas ilícitas, em especial, da cocaína é cada vez mais frequente, com o aumento consequente da quantidade de consultas de emergências relacionadas a suas complicações, incluindo o infarto do miocárdio. Os principais mecanismos fisiopatológicos que contribuem de forma aguda ou crônica para causar o infarto relacionado ao uso de cocaína são: vasoespasmo, aterosclerose, trombogenese mediada por aumento dos níveis de fatores pró-trombóticos associada com a elevação da agregação plaquetária, aumento da demanda de oxigênio pelo miocárdio. O tratamento do infarto agudo do miocárdio relacionado ao uso de cocaína é semelhante ao do infarto na população em geral, com ácido acetilsalicílico, nitratos e oxigênio. As diferenças estão no uso de benzodiazepínicos e na contraindicação do uso de beta-bloqueadores. Existe controvérsia quanto ao uso do labetalol e da terapia trombolítica. Está sob investigação o uso de novos medicamentos como a fentolamina para reverter os efeitos de vasoconstrição e dos inibidores plaquetários para evitar a progressão do trombo.

This article aims to review current pillars of the pathophysiology and treatment of acute myocardial infarction related to cocaine use. Cocaine use has become increasingly frequent, and consequently the number of medical emergencies has increased related to its complications, including myocardial infarction. Four seems to be the pathophysiological mechanisms that contribute acutely or chronically, to cause infarction related to cocaine use: vasospasm, atherosclerosis, thrombus formation mediated by increased levels of prothrombotic factors and increased platelet aggregation, and increased demand for myocardial oxygen. The cocaine related infarction treatment is similar to infarction in general population with aspirine, nitrates and oxigen therapy. The differences are based on the use of benzodiazepines and the non indication of beta blockers, in the first case. Labetalol and trombolitic therapy use are controversial. The patophisiology knowledgement plays an important role in the introduction of new medications specific to cocaine related infarction, like phentolamine and platelets inhibitors.

Uso de labetalol para hipotensión controlada en pacientes sometidos a cirugías de columna en el HEALF de octubre a diciembre del 2009 / Use of controlled hypotension for labetalol in patients undergoing spine surgery in October HEALF December 2009

Con el fin de conocer; si el uso de labetalol para hipotensión controladaproduce efectos benéficos en pacientes sometidos a cirugías de columna, serealizó un estudio descriptivo, prospectivo, longitudinal y observacional en los meses de Octubre Diciembre 2009, con una muestra de 20 pacientes en el hospital Antonio Lenin Fonseca. Nuestra fuente de información fue directa y primaria, ya que se evaluómediante una ficha de observación a los pacientes; elaborada por elinvestigador. A los pacientes, una vez en sala de operaciones se les premedicó. En lo que refiere a datos demográficos; el sexo que predominó fue el masculino, estado físico ASA II, con un promedio deedad de 47 años y un promedio de peso de 75 kg. 2. Los cambios hemodinámicos con este fármaco fueron de excelente estabilidad cardiaca y un estado hipotensor fácil de recupera. El tiempo de hipotensión promedio fue de 85 minutos. El número de dosis de refuerzo para obtener un estadohipotensor en promedio fue de 3 dosis. El sangrado estimado aproximado en promedio fue de 340 ml. El método no presentó reacciones adversas, interacciones medicamentosas o complicaciones. Se transfundió a un pequeño porcentaje de pacientes (15%)...

Late postpartum preeclampsia with posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome is a reversible syndrome characterized by headache, seizures, altered mentation, and loss of vision associated with white matter changes on imaging. We report here a 27 year-old lady three weeks postpartum, presenting with posterior reversible encephalopathy syndrome. She was treated successfully with antihypertensives and showed dramatic improvement. This condition is important to recognize and needs to be treated promptly to prevent morbidity and mortality in pregnancy and postpartum.

The Effectiveness of Labetalol for Treating Esmolol-resistant Tachycardia in a Patient Who was Under General Anesthesia : A case report

Esmolol is a cardioselective beta-blocker with a very rapid onset of action and a short half-life. Labetalol is a combined alpha- and beta-adrenoceptor blocking agent. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. A 51 year old female patient was transferred to the operating room for performing spinal fusion under general anesthesia. She had no operation and medication history. The initial heart rate was 150 beats/min. Despite administering several bolus injections of esmolol, the heart rate was not decreased to under 130 beats/min. But the heart rate was decreased to 100 beats/min after the administration of labetalol 5 mg and this rate was maintained without an additional injection. The vital signs were stable until the operation was finished and the patient recovered uneventfully in the recovery room. The postoperative laboratory findings revealed that she had hyperthyroidism. We report here on an anesthetic experience of effective labetalol treatment for esmolol-resistant tachycardia in a patient who was under general anesthesia.

Curso de Atualização em Emergências Médicas: aula 7: Acidente vascular encefálico / Updating Medical Emergencies Course: class 7: Encephalic vascular accident

O acidente vascular encefálico (AVE) é uma doença grave e constitui a terceira causa de morte e a primeira de seqüelas incapacitantes, em todo o mundo. Pode ser de tois tipos: isquêmico ou hemorrágico. A AVE isquêmico é mais comum (responsável por cerca de 80 por cento dos casos) e pode decorrer de trombose ou embolia das artérias cerebrais. O presente artigo destaca o quadro clínico, a conduta para diagnóstico e as medidas terapêuticas a serem adotadas, de acordo com a forma de apresentação do AVE. O autor enfatiza a importância da prevenção, a partir do reconhecimento e correção dos fatores de risco, a exemplo da hipertensão arterial

Comparative study of esmolol and labetalol to attenuate haemodynamic responses after electroconvulsive therapy.

OBJECTIVE: The study was designed to evaluate the hemodynamic effects of Esmolol and labetalol in patients undergoing electroconvulsive therapy. MATERIALS AND METHODS: Ninety patients undergoing electroconvulsive therapy treatment were studied according to randomized, double blind placebo controlled protocol. Ninety patients were divided into three groups with thirty patients in each group. Patients received either Esmolol (1 mg/kg), Labetalol (0.25 mg/kg) or Normal Saline (placebo) intravenously just after induction with propofol. The baseline heart rate and blood pressure were recorded. Hemodynamic parameters before and after drug therapy and after the ECT current application, were recorded at different time intervals. RESULTS: It was found that Esmolol significantly attenuated the degree of tachycardia and hypertension after ECT in comparison with placebo in the first three minutes (p<0.05), whereas the rise in HR and blood pressure was significantly blunted in the labetalol group in comparison to placebo, from three minutes onward till ten minutes. (p<0.05). CONCLUSION: It was concluded that Esmolol is effective in blunting the hemodynamic response after ECT stimulus in the first three minutes after application of the electrical current, whereas Labetalol is effective after five minutes onwards till ten minutes.

Tratamento anti-hipertensivo na gestação e lactação / Antihypertensive treatment in pregnancy and lactation

O Controle dos níveis de PA é parte importante do manejo de gestantes com hipertensão arterial, mormente daquelas em crise hipertensiva ou com hipertensão moderada, mas de longa duração. Hidralazina, nifedipina e labetalol são consideradas drogas de 1ª escolha para controle da hipertensão arterial aguda. Metildopa continua sendo a droga de eleição para o tratamento da manutenção. Hidralazina, nifedipina e verapamil são úteis também no tratamento de manutenção especialmente quando associados à metildopa. Os beta-bloqueadores podem também ser associados a um vasodilatador, embora possam provocar bradicardia fetal e neonatal. Os inibidores da ECA estão contraindicados na gestação, mas são drogas seguras após o parto, na lactação