Transesophageal echocardiographic assessment of left ventricular function in response to labetalol for control of postoperative hypertension.
Although labetalol (LAB), the combination of an alpha- and beta-adrenergic blocking agent, is thought to be effective and safe for the control of postoperative hypertension, no study has focused on changes in left ventricular (LV) function when this drug was used to control postoperative hypertension. Therefore, this study determined the effects of LAB on hemodynamics and LV function assessed by 2D transesophageal echocardiography (TEE) in 17 patients undergoing abdominal aortic surgery who experienced a postoperative hypertensive episode. Postoperatively, patients were transferred while still intubated and under fentanyl sedation to the postanesthesia care unit where a TEE probe was inserted to provide a short-axis view of the LV. When their systolic blood pressure increased above 165 mmHg for more than 4 minutes, LAB was given in a dose of 0.75 mg/kg IV, over 2 minutes. If the blood pressure was not lowered to within 10% of the preoperative values, additional doses of LAB were given. Control of hypertension was obtained in all patients and was associated with a significant decrease in heart rate (90 +/- 19 to 70 + 13 bpm), cardiac index (4.52 +/- 1.65 to 3.36 +/- 1.55 L/min/m2), and mixed venous oxygen saturation (73 +/- 10 to 63 +/- 10%). With the lower blood pressure, end-diastolic area increased, indicating myocardial depression. In conclusion, LAB can be used to effectively control hypertension during the early postoperative period after abdominal aortic surgery. However, the reduction of blood pressure is achieved principally by the negative inotropic effect of LAB, which predominates over its vasodilator action.
Le Bret
F
F
Department d'Anesthésiologie-Hôpital Pitié-Salpétrière, Paris, France.
Coriat
P
P
Gosgnach
M
M
Baron
J F
JF
Reiz
S
S
Viars
P
P
D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D001012:Aorta, Abdominal / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004452:Echocardiography / Q000379:methods; D004947:Esophagus; D006321:Heart / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007275:Injections, Intravenous; D007741:Labetalol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control*; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D014655:Vascular Resistance / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
D007741:Labetalol; D010100:Oxygen