Treatment of hypertension with labetalol in neurosurgical practice

Abstract

In neurosurgical patients autoregulation of cerebral perfusion is often lost. Therefore, a sudden increase in blood pressure may lead to an increase in cerebral blood flow and cerebral oedema may follow. The influence of labetalol, a new alpha- and beta-adrenoceptor blocking agent, on intracranial pressure and cerebral perfusion pressure was investigated in dogs without and with mass lesions. During hypotension with labetalol the intracranial pressure remained unchanged and the cerebral perfusion pressure decreased to the same extent as mean arterial pressure (30%). Labetalol seems to be suitable to treat hypertension perioperatively in neurosurgical patients but it is not a suitable drug for induced hypotension.

Retrospective evaluation of labetalol as antihypertensive agent in dogs

“…It often begins 10–20 min after surgery and may last up to 4 h and, despite the cause not being well understood, it is thought to be related to increased sympathetic tone and vasoactive substances release [ 39 ]. Labetalol has been demonstrated to be effective in reducing post-craniotomy emergence hypertension, causing effective reduction in blood pressure without affecting cerebral blood flow autoregulation [ 40 , 41 ]. Its action is quick after bolus administration, with onset of action of 10–20 s and peak effect after 5 min [ 42 ].…”

“…Its action is quick after bolus administration, with onset of action of 10–20 s and peak effect after 5 min [ 42 ]. Since intravenous labetalol does not produce a significant reduction in cerebral blood flow and it is easily titrated to effect, it may be the anti-hypertensive treatment of choice in patients who also have cerebrovascular disease, considering also the fact that it does not directly affect intracranial pressure [ 21 , 40 ].…”