Key result
Labetalol administered before the induction of anesthesia significantly attenuated the rise in blood pressure and heart rate during laryngoscopy and intubation compared to remifentanil in women with severe preeclampsia (P < 0.001).
Why the study?
Stress responses to laryngoscopy and intubation are exaggerated in severe preeclampsia, increasing risks of maternal morbidity and mortality, but the comparative efficacy of remifentanil versus labetalol in attenuating these responses was unclear.
Does labetalol improve hemodynamic stability compared to remifentanil in severe preeclamptic patients undergoing cesarean delivery with general anesthesia?
RCT (n=70)
Double-blind
Computer-created list of random numbers
No
Does labetalol improve hemodynamic stability compared to remifentanil in severe preeclamptic patients undergoing cesarean delivery with general anesthesia?
Prophylactic administration of labetalol before induction of anesthesia provides better hemodynamic stability than remifentanil during intubation in severe preeclamptic patients undergoing cesarean section.
Answers are grounded in this paper and cite their sources.
Labetalol warrants consideration over remifentanil to blunt intubation hemodynamics in severe preeclamptic cesarean deliveries under GA; extends RCT evidence for beta-blockade in obstetric anesthesia.
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.
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Rasooli et al. (2018) conducted an RCT in Severe preeclampsia (n=70). Labetalol vs. Remifentanil 1 µg/kg bolus IV was evaluated on Systolic blood pressure 1 minute after intubation (mm Hg) (p=<0.001). Labetalol administered before the induction of anesthesia significantly attenuated the rise in blood pressure and heart rate during laryngoscopy and intubation compared to remifentanil in women with severe preeclampsia (P < 0.001).
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