Comparison of Hemodynamic Changes Due to Endotracheal Intubation With Labetalol and Remifentanil in Severe Preeclamptic Patients Undergoing Cesarean Delivery With General Anesthesia

Abstract

Objectives: Stress replication to laryngoscopy and intubation are exaggerated in the patient with severe preeclampsia and this stress can lead to an increased risk of maternal mortality and morbidity. The aim of this study was to compare the efficacies of remifentanil and labetalol in attenuating these responses in women with violent preeclampsia undergoing cesarean section (C-section) with general anesthesia. Methods: In this double-blind study, 70 women with violent preeclampsia undergoing cesarean delivery were randomly assigned to two groups to receive either remifentanil 1 µg/kg or labetalol 0.25 mg/kg before the induction of anesthesia. Then, blood pressure (BP) and heart rate (HR) were measured before and 1, 3, and 5 minutes after the intubation. The first and 5th-minute Apgar scores were evaluated as well. Results: All hemodynamic variables decreased in both groups after the administration of remifentanil or labetalol. Labetalol significantly attenuated the rise in BP and HR during laryngoscopy and intubation compared to remifentanil (P<0.001). Eventually, no significant difference was found between the Apgar scores of the two groups (P=0.97 and P=0.19, respectively). Conclusion: Overall, the administration of labetalol before the inspiration of anesthesia can control stress replication to laryngoscopy and shows better intubation and more stability than remifentanil in patients with severe preeclampsia undergoing C-section.

Evaluation of Three- and Five-Year Disease-Free Survival in Patients With Cervical Cancer With Spinal Cord Metastasis Under Treatment With External Radiotherapy + Brachytherapy

“…Also, neoadjuvant chemotherapy in patients with cervical cancer can eradicate micrometastases, prevent tumor neovascularization, and reduce hypoxic cells (24)(25)(26).…”

Gestasyonel hipertansiyon ve güncel tedavi yaklaşımları

“…Genel anestezi, laringoskopi sırasında serebrovasküler kanamaya yol açabilen hava yolu problemleri ve artan sistemik ve serebral kan basınçları ile ilişkilidir. Laringoskopiye verilen hipertansif yanıt, IV alfentanil 25 mg/kg veya remifentanil 1 mg/kg gibi opioidler veya labetalol 0,25 mg/kg veya esmolol 500 mg/ kg IV bolus olarak uygulanabilecek diğer antihipertansif ilaçlardır (43). Kan basıncını indüksiyon öncesi değerlerde tutmayı ve ortalama arter basınçlarının 110 mmHg'nın altında tutmayı hedefleyin.…”

Update on hypertensive disorders in pregnancy

“…opioids such as alfentanil 25 mg kg À1 or remifentanil 1 mg kg À1 , or other antihypertensive drugs such as labetalol 0.25 mg kg À1 or esmolol 500 mg kg À1 bolus. 23 Aim to maintain BP at pre-induction values and prevent the increase of mean arterial pressures above 110 mmHg. Any anaesthesiarelated hypotension can be treated with i.v.…”