labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10–70) vs. 19.63 (10–25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.]]>
Airway Extubation ; Anesthesia ; Animals ; Arterial Pressure ; Atrioventricular Block ; Bradycardia ; Brain Neoplasms ; Carbon Dioxide ; Dexmedetomidine ; Dihydroergotamine ; Dogs ; Fever ; Heart Rate ; Hypertension ; Hypotension ; Hypothermia ; Labetalol ; Neurosurgery ; Observational Study ; Odds Ratio ; Retrospective Studies ; Seizures ; Tachycardia

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.
Aged ; Chemistry ; Female ; Humans ; Labetalol ; Life Style ; Muscular Diseases ; Nebivolol* ; Propranolol ; Rhabdomyolysis*

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.
Anesthesia, General ; Curettage ; Early Diagnosis ; Female ; Humans ; Hydatidiform Mole* ; Hypertension* ; Labetalol ; Pre-Eclampsia ; Pregnancy ; Sepsis ; Tachycardia* ; Thyroid Crisis* ; Thyroid Function Tests

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.
Aged ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Etomidate ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Intubation ; Isoflurane ; Labetalol ; Respiration ; Tachycardia ; Vecuronium Bromide

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 < 300 pg/ml, n = 66) and H-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.
Atropine ; Ephedrine ; Hemodynamics ; Humans ; Labetalol ; Natriuretic Peptide, Brain ; Nicardipine ; Nitroglycerin ; Peptide Fragments ; Phenylephrine ; Retrospective Studies

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.
Anesthesia, General ; Female ; Half-Life ; Heart Rate ; Humans ; Hyperthyroidism ; Labetalol ; Operating Rooms ; Propanolamines ; Recovery Room ; Spinal Fusion ; Tachycardia ; Vital Signs

A 39 year old man suffering from pheochromocytoma and coronay artery obstruction diseases was scheduled for coronary artery bypass graft surgery before an adrenalectomy. General anesthesia was induced with fentanyl and midazolam and maintained with intermittent administration of fentanyl and low concentraion of isoflurane. At 5 minutes after commencement of cardiopulmonary bypass (CPB), the mean arterial pressure suddenly elevated to 150 mmHg. Sodium nitroprusside and labetalol were administered rapidly, however, mean arterial pressure could not be lowered below 100 mmHg. After release of aortic cross clamp, the electrocardiography showed tachycardia (150 beats/min) with wide QRS and systolic arterial pressure elevated to 180 mmHg. Antiarrhythmic drugs, inotropic and antiischemic drugs were administered. Thereafter tachycardia was disappeared and systolic arterial pressure was lowered below 150 mmHg. We observed the paroxysmal hypertension and tachycardia during CPB that is considered to be attributed to the presence of pheochromocytoma. Therefore we suggest that continuous thoracic epidural anesthesia and pulsatile perfusion during CPB could be helpful in a patient with pheochromocytoma undergoing coronary artery bypass grafting.
Adrenalectomy ; Adult ; Anesthesia, Epidural ; Anesthesia, General ; Anti-Arrhythmia Agents ; Arterial Pressure ; Arteries ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Electrocardiography ; Fentanyl ; Humans ; Hypertension* ; Isoflurane ; Labetalol ; Midazolam ; Nitroprusside ; Pheochromocytoma* ; Pulsatile Flow ; Tachycardia ; Transplants

In the maxillofacial surgery, close care is mandatory during operation and anesthesia. The surgical field is limited since most procedure is done through the mouth. In this situation, airway management and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial surgery for bleeding control and accurate operation. One hundred and ninety-eight cases of maxillofacial surgery was carried out under induced hypotensive anesthesia from 1991 to 1999. Authors divided them into 4 groups based on the anesthetic protocol. In group 1(n = 43) inhalation anesthetics(enflurane, halothane) and sodium nitroprussde(SNP) were used; in group 2(n = 99) inhalation anesthetics(enflurane), SNP and labetalol were used; In group 3(n = 27) inhalation anesthetics(enflurane) and labetalol were used; In group 4(n = 29) total intravenous anesthesia(propofol, fentanyl, midazolam) was applied with SNP, and esmolol(or labetalol). The patient records were retrospectively studied during the operation and anesthesia, including degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during the operation, complications, and the period of hospitalization. Mean operation time of 4 groups decreased in order. The blood pressure was controllable without reflex tachycardia in beta-blocker using groups. Amount and incidence of transfusion was smaller in total intravenous anesthesia group. However there were no significant differences in total admission days and ICU stay periods between 4 groups.
Airway Management ; Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Fentanyl ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Inhalation ; Labetalol ; Mouth ; Reflex ; Retrospective Studies ; Sodium ; Surgery, Oral ; Tachycardia

BACKGROUND: The worst problem in anesthetic management of maxillofacial surgery is bleeding from bone cutting site. Induced hypotension reduces bleeding and minimizes the need for blood transfusion. This study was performed to evaluate the effects of induced hypotension with labetalol on blood loss and blood pressure in maxillofacial surgical patients. METHODS: Twenty-four adult patients, either sex, ASA physical status I or II, undergoing orthognathic surgery were randomly selected and divided into two groups; one group was administered 20 mg of labetalol and the other group was not. Anesthetic maintenance was consisted of O2-N2O-enflurane (2~2.5 vol%). Then 20 mg of labetalol was given intravenously at skin incision time in the labetalol group. Hemodynamic variables were recorded before induction of anesthesia, at the beginning of the labetalol infusion and at 10 min, 20 min, 30 min, 60 min and 90 min after the infusion. Blood loss determined by measuring the weight of the sponges and by measuring the volume of blood in suction-trap bottle. RESULTS: There was no significant difference in preoperative hemoglobin and postoperative hemoglobin between two groups. The amount of blood loss in the labetalol group (408 +/- 202 ml) was less than those in the control group (450 +/- 255 ml), but statistically not significant. The blood pressure was significantly decreased in the labetalol group than those of the control group at 20 minutes after the labetalol infusion. CONCLUSIONS: Labetalol is a useful agent for inducing hypotension. But 20 mg of labetalol was insufficient to decrease the blood loss. So I think the more amount of labetalol required to reduce the blood loss.
Adult ; Anesthesia ; Blood Pressure* ; Blood Transfusion ; Hemodynamics ; Hemorrhage ; Humans ; Hypotension* ; Labetalol* ; Orthognathic Surgery ; Porifera ; Skin ; Surgery, Oral

BACKGROUND: Sympathetic blocking agent, esmolol (selective beta 1 blocker) or labetalol ( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. METHODS: Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control (n=10), Group II:esmolol (n=11) and Group III: labetalol (n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure (RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. RESULTS: Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation ( p<0.05). Esmolol reduced the heart rate and the rate-pressure product than labetalol, but statistically there were no significance (P > 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups ( p<0.05). But there were no difference among groups (P>0.05). The side effects of esmolol and labetalol did not appear at all. CONCLUSION: 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation.
Adult ; Anesthesia, Inhalation ; Blood Pressure ; Catecholamines ; Dopamine ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Norepinephrine ; Operating Rooms ; Plasma ; Tachycardia