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Canadian Journal of Anaesthesia

, Volume 39, Issue 6, pp 559–562 | Cite as

A comparison of esmolol and labetalol for the treatment of perioperative hypertension in geriatric ambulatory surgical patients

  • Prithi Pal Singh
  • Ivan Dimich
  • Ian Sampson
  • Norman Sonnenklar
Article

Abstract

This is an open randomized study comparing the efficacy and safety of iv esmolol and labetalol in the treatment of perioperative hypertension in ambulatory surgery. Twenty-two elderly patients undergoing cataract surgery under local anaesthesia were studied. The main inclusion criteria were development of systolic blood pressure > 200 mmHg or diastolic > 100 mmHg. Esmolol was given as a bolus 500 μg · kg−1 iv followed by a maintenance infusion (150–300 μg · kg−1 · min−1). Labetalol was given as a bolus of 5 mg iv followed by 5 mg increments as needed up to a maximum of 1 mg · kg−1. Esmolol and labetalol both produced reductions in systolic and diastolic blood pressure (P < 0.05) within ten minutes of administration which lasted for at least two hours. Reduction of blood pressure by esmolol was accompanied by a decrease in HR (P < 0.05). Two patients developed extreme bradycardia (HR < 50 beats · min−1) and esmolol had to be discontinued. Labetalol, in contrast, induced only a moderate decrease in HR. None of the patients treated with labetalol experienced any prolonged side effects such as orthostatic hypotension. In conclusion, esmolol may produce considerable bradycardia in elderly patients when hypertension is not accompanied by tachycardia. Labetalol was easier to administer in the ambulatory setting and one-tenth the cost of esmolol.

Key words

anaesthesia: geriatric blood pressure: hypertension surgery: ambulatory sympathetic nervous system: pharmacology, esmolol, labetalol 

Résumé

Il s’agit d’une étude randomisée comparant l’efficacité et la sécurité du traitement avec esmolol et labétalol iv de l’hypertension peropératoire lors de la chirurgie ambulatoire. Nous avons étudié 22 patients âgés subissant une chirurgie pour cataracte sous anesthésie locale. Les critères d’inclusion principaux étaient l’apparition d’une tension artérielle systolique plus grande que 200 mmHg ou diastolique plus grande que 100 mmHg. Le traitement à l’esmolol comprenait un bolus de 500 μg · kg−1 iv suivi d’une perfusion de 150 a 300 μg · kg−1 · min−1. Le traitement au labétalol comprenait un bolus de 5 mg iv suivi d’une dose de 5 mg selon les besoins jusqu’à un maximum de 1 mg · kg−1. L’esmolol et le labétalol ont diminué les tensions artérielle systoliques et diastoliques (P < 0,05) en dedans de dix minutes après leur administration, effet qui a persisté pour au moins deux heures. La diminution de la tension artérielle par l’esmolol était accompagnée par une diminution de la fréquence cardiaque (P < 0,05). Deux patients ont présenté une bradycardie sévère (fréquence cardiaque < 50 battements · min−1) et l’esmolol a du être cessé. Le labétalol ne causait qu’une diminution modérée de la fréquence cardiaque. Aucun des patients traités avec labétalol n’a montré d’effets secondaires prolongés importants tel que l’hypotension orthostatique. En conclusion, l’esmolol peut causer une bradycardie importante chez les patients âgés lorsque Vhypertension n’est pas accompagnée de tachycardie. Le labétalol est plus facile à administrer dans le contexte ambulatoire, et ce à un coût dix fois moins important que l’esmolol.

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Copyright information

© Canadian Anesthesiologists 1992

Authors and Affiliations

  • Prithi Pal Singh
    • 1
    • 2
  • Ivan Dimich
    • 1
    • 2
  • Ian Sampson
    • 1
    • 2
  • Norman Sonnenklar
    • 1
    • 2
  1. 1.Department of AnesthesiologyMount Sinai HospitalNew YorkUSA
  2. 2.City Hospital Center at ElmhurstElmhurst

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