title: An Equivalence Trial Comparing Labetalol and Diltiazem in Controlling Emergence Hypertension after Supratentorial Tumor Surgery.
abstract: BACKGROUND
  Hypertension and tachycardia during emergence from anesthesia for craniotomy could increase risks of cerebral complications. Several anesthetic, sedative, and antihypertensive drugs have been suggested that may be successful at suppressing these unwanted hemodynamic consequences.
  
  
  OBJECTIVE
  To study the equivalent efficacy and side effects of two antihypertensive drugs, diltiazem and labetalol.
  
  
  METHODS
  A block randomized control trial was performed in 184 patients who developed emergence hypertensive response after craniotomyfor supratentorial tumor removal. Systolic blood pressure (SBP) of each patient was suppressed by 2.5 mg of study drugs and repeated with fix dosage of 2.5 mg every two to three minutes to maintain SBP lower than 140 mmHg with a cumulative dose within 20 mg. Data regarding demographic, successful rate in controlling hypertension, drug dosage, and incidence of side effects were analyzed.
  
  
  RESULTS
  The success rate of treatment of labetalol was equivalent to diltiazem (87.1% and 80.2% respectively) [p = 0.003, 95% CI = 6.88 (-2.06 to 15.8)]. There was no statistical significant difference on dosage of drugs used or incidence ofside effect (hypotension, bradycardia, heart block, and bronchospasm). Median (minimum-maximum) dosage of labetalol and diltiazem were 10 mg (2.5-20 mg) and 10 mg (2.5-20 mg) respectively. The expense for labetalol was 1/6 of diltiazem.
  
  
  CONCLUSIONS
  Labetalol has equivalent efficacy to diltiazem. Both drugs used low median dosage giving low incidence of side-effects. Labetalol is a good alternative drug to control hypertensive response during emergence from anesthesia for post-craniotomy.
authors.forename: Busara
authors.initials: B
authors.lastname: Sirivanasandha
authors.forename: Arerat
authors.initials: A
authors.lastname: Sakaew
authors.forename: Kulwadee
authors.initials: K
authors.lastname: Sutthivaiyakit
authors.forename: Kasana
authors.initials: K
authors.lastname: Raksamani
authors.forename: Pichaya
authors.initials: P
authors.lastname: Waitayawinyu
authors.forename: Pranee
authors.initials: P
authors.lastname: Rushatamukayanunt
authors.forename: Walaiporn
authors.initials: W
authors.lastname: Punkla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004110:Diltiazem / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007741:Labetalol / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015173:Supratentorial Neoplasms / Q000601:surgery; D013785:Thailand; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D004110:Diltiazem; D007741:Labetalol