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Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage.
Can J Anaesth. 2006 Jul; 53(7):678-83.CJ

Abstract

PURPOSE

Labetalol is an effective antihypertensive medication frequently used to treat systemic hypertension in acute care settings, including the management of hypertension associated with a subarachnoid hemorrhage. We present a case of profound hypotension, refractory to inotropic and vasopressor therapy following an iv infusion of labetalol.

CLINICAL FEATURES

Initiation of an iv labetalol infusion resulted in good blood pressure control in a patient suffering from a Fisher grade 3 subarachnoid hemorrhage with an initial Glascow coma scale of 14/15 and mild hydrocephalus. Progressive deterioration of neurological symptoms and evidence of worsening hydrocephalus preceded the sudden development of profound hypotension (60/35 mmHg) and bradycardia with a minimum heart rate of 40 beats.min(-1). Initial resuscitative efforts included administration of intravascular fluid, hypertonic saline, atropine, adrenalin (more than 10 mg in divided doses) and noradrenalin. These measures restored the blood pressure to 80/45 with a HR of 98 beats.min(-1). Intraoperative placement of an intraventricular drain released cerebrospinal fluid under pressure with an initial intracranial pressure of 15 cm H(2)O. A combination of adrenalin, noradrenalin, dopamine and vasopressin infusions were required to restore the blood pressure to 130/65 mmHg after an additional two hours. All inotropic and vasopressor support was weaned off after the 14th hr (about two drug half-lives). The patient was awake and responsive the following day, with no obvious neurological consequences. No evidence of neurological injury, drug administration error or myocardial dysfunction was documented.

CONCLUSION

The episode of profound hypotension which occurred after initiating a labetolol infusion required maximal combined vasopressor therapy to restore the blood pressure suggesting that this patient demonstrated an extreme sensitivity to labetalol. Combination therapy with adrenergic and nonadrenergic agonists may be required for optimal treatment of profound hypotension associated with labetalol-induced vasoplegia.

Authors+Show Affiliations

Jivraj S
Department of Anesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Mazer CD
No affiliation info available
Baker AJ
No affiliation info available
Choi M
No affiliation info available
Hare GM
No affiliation info available

MeSH

Antihypertensive AgentsBradycardiaCardiotonic AgentsDopamineEpinephrineFemaleHumansHypotensionIntracranial AneurysmLabetalolMiddle AgedNorepinephrineSubarachnoid HemorrhageTime FactorsVasoconstrictor AgentsVasopressins

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16803915

Citation

Jivraj, Sana, et al. "Case Report: Profound Hypotension Associated With Labetalol Therapy in a Patient With Cerebral Aneurysms and Subarachnoid Hemorrhage." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 53, no. 7, 2006, pp. 678-83.
Jivraj S, Mazer CD, Baker AJ, et al. Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage. Can J Anaesth. 2006;53(7):678-83.
Jivraj, S., Mazer, C. D., Baker, A. J., Choi, M., & Hare, G. M. (2006). Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 53(7), 678-83.
Jivraj S, et al. Case Report: Profound Hypotension Associated With Labetalol Therapy in a Patient With Cerebral Aneurysms and Subarachnoid Hemorrhage. Can J Anaesth. 2006;53(7):678-83. PubMed PMID: 16803915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage. AU - Jivraj,Sana, AU - Mazer,C David, AU - Baker,Andrew J, AU - Choi,Mabel, AU - Hare,Gregory M T, PY - 2006/6/29/pubmed PY - 2006/12/27/medline PY - 2006/6/29/entrez SP - 678 EP - 83 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 53 IS - 7 N2 - PURPOSE: Labetalol is an effective antihypertensive medication frequently used to treat systemic hypertension in acute care settings, including the management of hypertension associated with a subarachnoid hemorrhage. We present a case of profound hypotension, refractory to inotropic and vasopressor therapy following an iv infusion of labetalol. CLINICAL FEATURES: Initiation of an iv labetalol infusion resulted in good blood pressure control in a patient suffering from a Fisher grade 3 subarachnoid hemorrhage with an initial Glascow coma scale of 14/15 and mild hydrocephalus. Progressive deterioration of neurological symptoms and evidence of worsening hydrocephalus preceded the sudden development of profound hypotension (60/35 mmHg) and bradycardia with a minimum heart rate of 40 beats.min(-1). Initial resuscitative efforts included administration of intravascular fluid, hypertonic saline, atropine, adrenalin (more than 10 mg in divided doses) and noradrenalin. These measures restored the blood pressure to 80/45 with a HR of 98 beats.min(-1). Intraoperative placement of an intraventricular drain released cerebrospinal fluid under pressure with an initial intracranial pressure of 15 cm H(2)O. A combination of adrenalin, noradrenalin, dopamine and vasopressin infusions were required to restore the blood pressure to 130/65 mmHg after an additional two hours. All inotropic and vasopressor support was weaned off after the 14th hr (about two drug half-lives). The patient was awake and responsive the following day, with no obvious neurological consequences. No evidence of neurological injury, drug administration error or myocardial dysfunction was documented. CONCLUSION: The episode of profound hypotension which occurred after initiating a labetolol infusion required maximal combined vasopressor therapy to restore the blood pressure suggesting that this patient demonstrated an extreme sensitivity to labetalol. Combination therapy with adrenergic and nonadrenergic agonists may be required for optimal treatment of profound hypotension associated with labetalol-induced vasoplegia. SN - 0832-610X UR - https://www.unboundmedicine.com/medline/citation/16803915/Case_report:_profound_hypotension_associated_with_labetalol_therapy_in_a_patient_with_cerebral_aneurysms_and_subarachnoid_hemorrhage_ L2 - https://doi.org/10.1007/BF03021626 DB - PRIME DP - Unbound Medicine ER -