An Equivalence Trial Comparing Labetalol and Diltiazem in Controlling Emergence Hypertension after Supratentorial Tumor Surgery.

BACKGROUND: Hypertension and tachycardia during emergence from anesthesia for craniotomy could increase risks of cerebral complications. Several anesthetic, sedative, and antihypertensive drugs have been suggested that may be successful at suppressing these unwanted hemodynamic consequences. OBJECTIVE: To study the equivalent efficacy and side effects of two antihypertensive drugs, diltiazem and labetalol. MATERIAL AND METHOD: A block randomized control trial was performed in 184 patients who developed emergence hypertensive response after craniotomyfor supratentorial tumor removal. Systolic blood pressure (SBP) of each patient was suppressed by 2.5 mg of study drugs and repeated with fix dosage of 2.5 mg every two to three minutes to maintain SBP lower than 140 mmHg with a cumulative dose within 20 mg. Data regarding demographic, successful rate in controlling hypertension, drug dosage, and incidence of side effects were analyzed. RESULTS: The success rate of treatment of labetalol was equivalent to diltiazem (87.1% and 80.2% respectively) [p = 0.003, 95% CI = 6.88 (-2.06 to 15.8)]. There was no statistical significant difference on dosage of drugs used or incidence ofside effect (hypotension, bradycardia, heart block, and bronchospasm). Median (minimum-maximum) dosage of labetalol and diltiazem were 10 mg (2.5-20 mg) and 10 mg (2.5-20 mg) respectively. The expense for labetalol was 1/6 of diltiazem. CONCLUSION: Labetalol has equivalent efficacy to diltiazem. Both drugs used low median dosage giving low incidence of side-effects. Labetalol is a good alternative drug to control hypertensive response during emergence from anesthesia for post-craniotomy.

Blood glucose level in neurosurgery. Is it different between isoflurane and desflurane anesthesia?

AIM: A tight control of blood glucose is critical. We compare blood glucose level between isoflurane and desflurane in neurosurgical patients for further application. METHODS: One hundred and eight patients scheduled for neurosurgery under general anesthesia were recruited and divided into two groups; fentanyl-isoflurane-nitrous oxide based and fentanyl-desflurane-nitrous oxide based randomly. Vital signs, end tidal gas concentration, amount of narcotics usage and blood glucose level were recorded at induction (T0) and intraoperative hourly thereafter (T1-T8). Independent t-test and ANOVA were used. The statistical significance was considered if p-value < 0.05. RESULTS: There were 107 patients enrolled excluded one from isoflurane group because of the schedule changes. The amounts of fentanyl usage (0.89+/-0.41 mcg/kg/hr, 0.88+/-0.48 mcg/kg/hr), the end tidal inhales' tension (0.71%+/-0.32, 3.13%+/-1.63) were equivalent in isoflurane and desflurane group. The blood glucose levels at various period of time had no statistical difference but there was a significant (p<0.05) increasing from T1 to T8 comparing to T0 in both groups (3.88+/-0.93 mg%/hr and 5.55+/-1.14 mg%/hr). CONCLUSION: Desflurane has demonstrated the indistinguishable blood glucose level and hemodynamic response from isoflurane anesthesia intraoperatively in neurosurgical patients, confirming a comparable pattern of blood glucose concentration intensifying over time spends.