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Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery.
Anesthesiology. 1989 Dec; 71(6):835-9.A

Abstract

Hypertension is common following coronary artery bypass surgery. The safety of labetalol, a recently released combined alpha-1 and beta-adrenergic blocking agent for treatment of hypertension in this clinical situation is controversial. The authors compared the hemodynamic effects of labetalol with those of sodium nitroprusside (SNP) in 91 patients with good left ventricular function and equally severe coronary artery disease and in whom coronary artery bypass surgery had been just completed. They were anesthetized using fentanyl, diazepam, and enflurane. If hypertension developed postoperatively, patients were randomized to receive labetalol, 2 mg/min to a maximum of 300 mg (20 patients) or sodium nitroprusside in 0.5 micrograms.kg-1.min-1 increments by infusion (20 patients) to return blood pressure to normal. Compared with control values, labetalol brought about significant (P less than 0.05) reductions in heart rate, and cardiac index. No change was noted in stroke volume or systemic vascular resistance, but slight increases were found in central venous pressure and pulmonary capillary wedge pressure. Sodium nitroprusside treatment caused significant increases in heart rate and cardiac index while reducing diastolic blood pressure, central venous pressure, and pulmonary capillary wedge pressure. Stroke volume remained unchanged. Following the study period, blood pressure was controlled in all patients with SNP. Total doses of SNP in the 16 h following the study period were significantly less in the labetalol group (46.6 +/- 11.7 mg) versus (116.1 +/- 10.3 mg) in the SNP group (P less than 0.05). In this clinical circumstance, labetalol can be safe and effective for controlling hypertension, but its mechanism of achieving this effect varies from that for sodium nitroprusside.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors+Show Affiliations

Cruise CJ
Department of Anesthesia, Toronto Western Hospital, Ontario, Canada.
Skrobik Y
No affiliation info available
Webster RE
No affiliation info available
Marquez-Julio A
No affiliation info available
David TE
No affiliation info available

MeSH

AdultAgedCoronary Artery BypassFerricyanidesHumansHypertensionInfusions, IntravenousLabetalolMiddle AgedNitroprussidePostoperative ComplicationsRandomized Controlled Trials as Topic

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

2686494

Citation

Cruise, C J., et al. "Intravenous Labetalol Versus Sodium Nitroprusside for Treatment of Hypertension Postcoronary Bypass Surgery." Anesthesiology, vol. 71, no. 6, 1989, pp. 835-9.
Cruise CJ, Skrobik Y, Webster RE, et al. Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery. Anesthesiology. 1989;71(6):835-9.
Cruise, C. J., Skrobik, Y., Webster, R. E., Marquez-Julio, A., & David, T. E. (1989). Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery. Anesthesiology, 71(6), 835-9.
Cruise CJ, et al. Intravenous Labetalol Versus Sodium Nitroprusside for Treatment of Hypertension Postcoronary Bypass Surgery. Anesthesiology. 1989;71(6):835-9. PubMed PMID: 2686494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery. AU - Cruise,C J, AU - Skrobik,Y, AU - Webster,R E, AU - Marquez-Julio,A, AU - David,T E, PY - 1989/12/1/pubmed PY - 1989/12/1/medline PY - 1989/12/1/entrez SP - 835 EP - 9 JF - Anesthesiology JO - Anesthesiology VL - 71 IS - 6 N2 - Hypertension is common following coronary artery bypass surgery. The safety of labetalol, a recently released combined alpha-1 and beta-adrenergic blocking agent for treatment of hypertension in this clinical situation is controversial. The authors compared the hemodynamic effects of labetalol with those of sodium nitroprusside (SNP) in 91 patients with good left ventricular function and equally severe coronary artery disease and in whom coronary artery bypass surgery had been just completed. They were anesthetized using fentanyl, diazepam, and enflurane. If hypertension developed postoperatively, patients were randomized to receive labetalol, 2 mg/min to a maximum of 300 mg (20 patients) or sodium nitroprusside in 0.5 micrograms.kg-1.min-1 increments by infusion (20 patients) to return blood pressure to normal. Compared with control values, labetalol brought about significant (P less than 0.05) reductions in heart rate, and cardiac index. No change was noted in stroke volume or systemic vascular resistance, but slight increases were found in central venous pressure and pulmonary capillary wedge pressure. Sodium nitroprusside treatment caused significant increases in heart rate and cardiac index while reducing diastolic blood pressure, central venous pressure, and pulmonary capillary wedge pressure. Stroke volume remained unchanged. Following the study period, blood pressure was controlled in all patients with SNP. Total doses of SNP in the 16 h following the study period were significantly less in the labetalol group (46.6 +/- 11.7 mg) versus (116.1 +/- 10.3 mg) in the SNP group (P less than 0.05). In this clinical circumstance, labetalol can be safe and effective for controlling hypertension, but its mechanism of achieving this effect varies from that for sodium nitroprusside.(ABSTRACT TRUNCATED AT 250 WORDS) SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/2686494/Intravenous_labetalol_versus_sodium_nitroprusside_for_treatment_of_hypertension_postcoronary_bypass_surgery_ DB - PRIME DP - Unbound Medicine ER -