EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION IN MODIFIED ECT CO –AUTHORS PROF & HOD...

EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION IN MODIFIED ECT

CO –AUTHORS PROF & HOD DR.I.CHANDRASEKARAN MD.,DA.PROF.DR.S.G.GANESHPRABHU MD.,DA.GUIDE: DR.D.S.SUDHAHAR MD.,DNB.

DR.R.RAJA MURUGAN DA –PG.INSTITUTE OF ANAESTHESIOLOGY

MMC-MADURAI.

AIMTO ASSESS THE EFFICACY OF LABETALOL

FOR STRESS RESPONSE ATTENUATION IN MODIFIDED ECT.

INTRODUCTIONMODIFIED ECT IS AN USEFUL MODALITY IN

THE TREATMENT OF MAJOR DEPRESSIVE DISORDERS. IT IS ALSO USED IN ACUTE AND CHRONIC SCHIZOPHRENIA, ACUTE MANIA & PSYCHOSOMATIC STATES.

HISTORICALLY ECT WAS PERFORMED WITHOUT ANESTHESIA BUT NOWADAYS IT IS DONE UNDER GENERAL ANESTHESIA WITH MUSCLE RELAXATION TO AVOID RISK OF LONG BONE & VERTEBRAL FRACTURES FROM VIOLENT MUSCLE CONTRACTIONS

ECT IS ASSOCIATED WITH SIGNIFICANT HYPERTENSION, TACHYCARDIA & INCREASE IN CARDIAC OUTPUT.

A HYPER DYNAMIC CVS RESPONSE OCCURS DUE TO ACTIVATION OF THE AUTONOMIC NERVOUS SYSTEM

INITIAL PARASYMPATHETIC RESPONSE OCCURS FOLLOWED BY A SYMPATHETIC RESPONSE WHICH CAUSES TACHYCARDIA & ARTERIAL HYPERTENSION.

THEREFORE IT MAY BE BENEFICIAL TO ADMINISTER A SHORT ACTING BETA BLOCKER OR MIXED ALPHA-BETA BLOCKER TO BLUNT THE CATECHOLAMINE STRESS RESPONSE.

THESE HEMODYNAMIC CHANGES PRODUCE AN ABRUPT INCREASE IN MYOCARDIAL OXYGEN CONSUMPTION .

MATERIALS AND METHODSProspective, randomized, placebo

controlled.double blinded study.Ethical committee approvalWritten informed consentInclusion criteria: 60 patients undergoing modifided ECT( Age20-

60) ASA I&II

Exclusion criteria:ASA III &IVHeart Block >I st degreeHeart Rate < 50/minSystolic Bp < 90 mmhgH/O Bronchospasm/ COPD/Bronchial AsthmaH/O Drug Allergy.

Methods of study: All the patients receiveInj.Atropine 0.6mg IV & preoxygenated with

100% oxygen and induced with Inj.Thiopentone 3mg/kg/wt and Inj.suxa 1mg/kg/wt and ECT shock current is applied after 5mins from the time of administration of test drug. All the patients receive only one shock per treatment.

Study group: receive Inj.LABETOLOL 0.25mg/kg/wt 5mins before ECT.

Control group: Normal saline.

Parameters observed1.Heart Rate2.Blood pressure3.spo2These readings were noted before (base line)

and 1min after administration of test drug .After ECT the parameters were observed

after1, 3, 5, 10 mins. ECT current voltage was 125volts

LABETALOLIT IS AN UNIQUE PARENTERAL AND

ORAL ANTI HYPERTENSIVE DRUG THAT EXHIBITS SELECTIVE ALPHA 1 AND NON SELECTIVE B1 AND B2 ADRENERGIC ANTAGONIST EFFECTS.

LABETALOL LOWERS THE SYSTEMIC BP BY DECREASING SVR (A1 BLOCKADE) WHEREAS REFLEX TACHYCADIA TRIGGERED BY VASODIALATION IS ATTENUATED BY BETA BLOCKADE.

THE SYSTEMIC BP LOWERING EFFECT OF AN IV DOSE OF LABETALOL (0.1 to 0.5mg/kg/wt)

IS PRESENT IN 5-10MINS.SIDE EFFECTS:1.ORTHOSTATIC HYPOTENSION 2.BRONCHOSPASM3.BRADYCARDIA4.HEART BLOCK

RESULTS…LABETALOL GROUPCASE Age/IP baseli

ne1min ect1M

IN3MIN 5MIN 10MI

N

1 20/M25250

120/80,100

130/80102

140/100122

140/100124

140/90120

136/90124

2 16/F22138

130/80110

120/80120

140/90118

140/90112

140/100114

130/90102

3 34/F18633

110/8092

110/8090

100/8088

100/7088

100/6086

100/7090

4 21/M26450

120/80110

130/90106

150/100124

150/110122

160/110122

150/100112

5 30/M29726

140/8086

140/8088

160/11096

160/110112

150/110112

150/100102

6 30/F28120

130/8084

140/8488

150/9096

150/9098

150/9096

140/10098

7 22/M38873

130/9086

130/8086

140/10096

150/90100

150/100102

150/96104

8 22/M25145

130/9096

130/9098

150/110112

150/100116

140/110114

140/90110

9 21/M26450

120/90100

120/90102

140/100116

150/110120

150/110114

140/100112

10 35/F26988

100/6088

100/6084

120/80100

130/84102

130/8098

130/80102

11 20/M25460

130/100102

130/100120

150/110118

150/100122

150/96118

140/90102

12 30/F38873

140/90112

140/90114

160/110122

170/110124

160/110120

150/100122

13 24/F02271

120/8094

120/9096

140/100102

140/100110

144/100112

140/90110

14 24/F22711

110/70112

110/80114

140/90112

140/100110

140/100100

140/100102

15 24/F28428

110/8098

114/80100

140/100114

144/100120

140/90116

140/86112

16 33/M36185

120/90110

124/88112

150/100116

144/96120

144/90114

140/88110

17 15/M03887

110/7088

110/7092

136/98108

140/98110

140/90112

128/8898

18 23/F35647

130/9090

130/9090

144/90100

140/100102

140/9098

128/8896

19 21/F36790

100/7088

110/7092

150/90108

144/90112

140/90112

130/8698

20 27/M38698

120/8078

120/8278

138/9096

144/9098

144/9096

130/8888

21 21/M41212

120/7088

120/8084

144/9896

150/100102

150/98100

130/9098

22 36/M41641

120/90100

120/90102

140/100114

150/110118

150/110118

140/100110

23 26/F43460

100/6088

100/6086

130/100100

134/100102

130/90102

130/8696

24 22/F42927

130/9088

130/9088

144/10098

150/100100

150/9098

140/9096

25 29/M43806

100/6088

100/6090

130/90108

136/90110

130/9098

126/8898

26 31/M43117

110/8090

110/8092

130/100114

130/100116

130/90108

130/8498

27 30/M29736

110/7086

100/7088

140/9498

144/90100

140/9098

130/9096

28 24/F22711

120/7098

120/70100

144/90122

140/100120

140/90110

130/90110

29 30/F28180

130/8088

130/8088

150/100112

150/100112

144/100108

140/90100

30 16/F22138

100/7096

100/8090

130/100102

136/100112

130/96106

130/9098

CONTROL GROUP…CASE AGE/

IPbaseline

1MIN ECT 1MIN

3min 5min 10min

1 24/F2271

120/8094

120/8092

170/110130

180/110132

170/100126

160/100122

2 26/F25384

130/8096

130/8096

170/110140

170/110144

160/110138

150/110128

3 30/M29726

140/8088

140/9092

190/120126

180/110136

170/120132

160/110128

4 22/M38873

130/70112

130/80114

200/120138

190/120144

190/110140

170/110126

5 20/M25250

110/80102

120/88108

180/120132

170/120136

170/100122

150/110120

06 21/M26450

120/8090

120/8090

170/120140

180/120152

160/110130

150/110124

07 30/F28120

110/8082

110/8084

160/110144

170/120140

160/110/126

160/90118

08 16/F22138

130/8088

130/8086

170/100122

170/110132

160/100130

150/100120

09 24/F28428

120/7076

120/7074

170/100104

170/100114

170/90104

150/9098

10 22/M38873

100/7080

100/7078

150/10098

160/110108

150/100102

140/10098

11 15/M3887

110/7078

110/7080

170/120122

170/120120

160/110110

150/110108

12 33/M36185

130/8088

130/8090

180/130134

170/120124

160/120120

160/110108

13 23/F35647

120/7094

120/8090

170/110146

170/110134

170/100122

150/90112

14 21/F36790

110/8088

110/8086

160/110124

170/110130

160/100120

150/90100

15 36/M41641

120/8090

120/9090

160/110130

160/100126

150/100108

146/100110

16 21/M41212

110/8078

110/8080

180/100108

170/110110

170/100112

160/9098

17 20/F40902

120/7072

120/7070

150/100112

160/110100

160/100110

150/100100

18 26/F 43460

100/6068

100/6068

150/110102

150/100100

148/90102

140/9090

19 22/M42927

110/7086

110/70/88

160/11098

170/98108

170/100110

160/90100

20 29/M 43806

130/9090

130/9092

180/110112

170/110114

160/100106

150/100100

21 31/F43117

100/7072

100/7072

150/110102

160/110112

160/110110

140/100108

22 17/F40067

120/8078

120/8088

160/120114

160/120116

150/100100

150/10098

23 23/F35646

130/9078

130/9078

170/120114

170/110112

160/10080

140/9078

24 33/M36185

110/8078

110/8080

150/100102

150/90100

150/9098

140/9094

25 43/M38699

100/6076

100/6078

160/100102

160/110104

150/100100

140/9090

26 36/M44990

120/7088

120/7090

160/120/122

160/120120

160/110110

150/100100

27 26/F43460

120/7068

120/7070

170/110110

170/110108

160/100108

160/9098

28 29/M43860

130/8088

130/8086

180/100124

170/120120

170/120112

158/100102

29 31/F43112

130/8080

130/8084

170/120118

170/110118

150/90100

150/9098

30 22/M 42927

100/8080

100/8080

160/110130

160/100126

160/100122

160/9090

RESULTS & ANALYSIS….

SYSTOLIC BLOOD PRESSURE

110

120

130

140

150

160

170

180

Baseline 1 min. 1 min, afterECT

3 minutes 5 minutes 10 minutes

LABETALOL GROUP CONTROL GROUP

110

120

130

140

150

160

170

180

Baseline 1 min. 1 min, afterECT



RISE IN SYSTOLIC BLOOD PRESSURE

0

10

20

30

40

50

60

1 min. 1 min, afterECT



DIASTOLIC BLOOD PRESSURE

70

80

90

100

110

120

Baseline 1 min. 1 min. afterECT



RISE IN DIASTOLIC BLOOD PRESSURE

0

10

20

30

40

1 min. 1 min. afterECT



HEART RATE

90

100

110

120

130

Baseline 1 min. 1 min. afterECT



RISE IN HEART RATE

0

10

20

30

40

1 min. 1 min. afterECT



SYSTOLIC BLOOD

PRESSURE AT

LABETALOL

GROUP

CONTROL

GROUP“p”

Base line 118.7+ 12 117.7+ 11.4 0.7487 Not

significant

After 1 minute (before

ECT)

119.6+ 12.5 118+ 11.3 0.595 Not

significant

1 minute after ECT 140.9+ 11.7 167.3+ 12.3 0.0001 Significant

3 minutes after ECT 143.2+ 11.7 167.7+ 8.6 0.0001 Significant



DIASTOLIC BLOOD

PRESSURE AT

LABETALOL

GROUP

CONTROL

GROUP“p”

Base line 79.0 + 10.3 76 + 7.20.1858 Not significant

After 1 minute (before

ECT)

80.5 + 12.5 77.6 + 8.10.1233 Not significant

1 minute after ECT 97.0 + 7.8 111 + 8.40.0001 Significant

3 minutes after ECT 97.6 + 8.7 110.6 + 80.0001 Significant

5 minutes after ECT 95 + 10.6 103 + 8.40.0013 Significant

10 minutes after ECT 90.6 + 6.8 98 + 8.10.0002 Significant

HEART

RATE AT

LABETALO

L GROUP

CONTROL

GROUP“p”

Base line 94.5+ 9.3 90.2+ 8.80.1856 Not significant

After 1 minute

(before ECT)

96+ 11.2 91.1+ 9.30.1722 Not significant

1 minute after ECT 107.6+ 10.0 120 + 14.50.0007 Significant

3 minutes after ECT 110.5+ 9.4 121.3 + 14.30.0051 Significant

5 minutes after ECT 107.4+ 9.1 115.7 + 12.10.0087 Significant

10 minutes after

ECT

103.1+ 8.4 112.5 + 9.10.0006 Significant

CONCLUSION

Labetolol when given in a dosage of 0.25 mg/Kg body weight does DECREASE the STRESS RESPONSE in Modified ECT.

(Statistical analysis was done chi-square test)

EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION IN MODIFIED ECT CO –AUTHORS PROF & HOD...

Documents

Transcript of EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION IN MODIFIED ECT CO –AUTHORS PROF & HOD...