EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION IN MODIFIED ECT

1
EFFECTIVENESS OF LABETALOL FOR STRESS ATTENUATION
IN MODIFIED ECT

• CO AUTHORS
• PROF HOD
• DR.I.CHANDRASEKARAN MD.,DA.
• PROF.DR.S.G.GANESHPRABHU MD.,DA.
• GUIDE DR.D.S.SUDHAHAR MD.,DNB.
• DR.R.RAJA MURUGAN DA PG.
• INSTITUTE OF ANAESTHESIOLOGY
• MMC-MADURAI.

2
AIM

• TO ASSESS THE EFFICACY OF LABETALOL FOR STRESS
  RESPONSE ATTENUATION IN MODIFIDED ECT.

3
INTRODUCTION

• MODIFIED ECT IS AN USEFUL MODALITY IN THE
  TREATMENT OF MAJOR DEPRESSIVE DISORDERS. IT IS
  ALSO USED IN ACUTE AND CHRONIC SCHIZOPHRENIA,
  ACUTE MANIA PSYCHOSOMATIC STATES.
• HISTORICALLY ECT WAS PERFORMED WITHOUT ANESTHESIA
  BUT NOWADAYS IT IS DONE UNDER GENERAL ANESTHESIA
  WITH MUSCLE RELAXATION TO AVOID RISK OF LONG BONE
  VERTEBRAL FRACTURES FROM VIOLENT MUSCLE
  CONTRACTIONS

4

• ECT IS ASSOCIATED WITH SIGNIFICANT HYPERTENSION,
  TACHYCARDIA INCREASE IN CARDIAC OUTPUT.
• A HYPER DYNAMIC CVS RESPONSE OCCURS DUE TO
  ACTIVATION OF THE AUTONOMIC NERVOUS SYSTEM
• INITIAL PARASYMPATHETIC RESPONSE OCCURS FOLLOWED
  BY A SYMPATHETIC RESPONSE WHICH CAUSES
  TACHYCARDIA ARTERIAL HYPERTENSION.

5

• THEREFORE IT MAY BE BENEFICIAL TO ADMINISTER A
  SHORT ACTING BETA BLOCKER OR MIXED ALPHA-BETA
  BLOCKER TO BLUNT THE CATECHOLAMINE STRESS
  RESPONSE.
• THESE HEMODYNAMIC CHANGES PRODUCE AN ABRUPT
  INCREASE IN MYOCARDIAL OXYGEN CONSUMPTION .

6
MATERIALS AND METHODS

• Prospective, randomized, placebo
  controlled.double blinded study.
• Ethical committee approval
• Written informed consent
• Inclusion criteria 60 patients undergoing
• modifided
  ECT( Age20-60)
• ASA III

7

• Exclusion criteriaASA III IV
• Heart Block gtI st degree
• Heart Rate lt 50/min
• Systolic Bp lt 90 mmhg
• H/O Bronchospasm/ COPD/Bronchial Asthma
• H/O Drug Allergy.

8

• Methods of study
• All the
  patients receive
• Inj.Atropine 0.6mg IV preoxygenated with 100
  oxygen and induced with Inj.Thiopentone 3mg/kg/wt
  and Inj.suxa 1mg/kg/wt and ECT shock current
  is applied after 5mins from the time of
  administration of test drug. All the patients
  receive only one shock per treatment.
• Study group receive Inj.LABETOLOL 0.25mg/kg/wt
  5mins before ECT.
• Control group Normal saline.

9

• Parameters observed
• 1.Heart Rate
• 2.Blood pressure
• 3.spo2
• These readings were noted before (base line) and
  1min after administration of test drug .
• After ECT the parameters were observed after1, 3,
  5, 10 mins.
• ECT current voltage was 125volts

10
LABETALOL

• IT IS AN UNIQUE PARENTERAL AND ORAL ANTI
  HYPERTENSIVE DRUG THAT EXHIBITS SELECTIVE ALPHA
  1 AND NON SELECTIVE B1 AND B2 ADRENERGIC
  ANTAGONIST EFFECTS.
• LABETALOL LOWERS THE SYSTEMIC BP BY DECREASING
  SVR (A1 BLOCKADE) WHEREAS REFLEX TACHYCADIA
  TRIGGERED BY VASODIALATION IS ATTENUATED BY BETA
  BLOCKADE.

11

• THE SYSTEMIC BP LOWERING EFFECT OF AN IV DOSE OF
  LABETALOL (0.1 to 0.5mg/kg/wt)
• IS PRESENT IN 5-10MINS.
• SIDE EFFECTS
• 1.ORTHOSTATIC HYPOTENSION
• 2.BRONCHOSPASM
• 3.BRADYCARDIA
• 4.HEART BLOCK

12
RESULTSLABETALOL GROUP
CASE Age/IP baseline 1min ect1MIN 3MIN 5MIN 10MIN
1 20/M 25250 120/80, 100 130/80 102 140/100 122 140/100 124 140/90 120 136/90 124
2 16/F 22138 130/80 110 120/80 120 140/90 118 140/90 112 140/100 114 130/90 102
3 34/F 18633 110/80 92 110/80 90 100/80 88 100/70 88 100/60 86 100/70 90
4 21/M 26450 120/80 110 130/90 106 150/100 124 150/110 122 160/110 122 150/100 112
5 30/M 29726 140/80 86 140/80 88 160/110 96 160/110 112 150/110 112 150/100 102
6 30/F 28120 130/80 84 140/84 88 150/90 96 150/90 98 150/90 96 140/100 98
7 22/M 38873 130/90 86 130/80 86 140/100 96 150/90 100 150/100 102 150/96 104

13
8 22/M 25145 130/90 96 130/90 98 150/110 112 150/100 116 140/110 114 140/90 110
9 21/M 26450 120/90 100 120/90 102 140/100 116 150/110 120 150/110 114 140/100 112
10 35/F 26988 100/60 88 100/60 84 120/80 100 130/84 102 130/80 98 130/80 102
11 20/M 25460 130/100 102 130/100 120 150/110 118 150/100 122 150/96 118 140/90 102
12 30/F 38873 140/90 112 140/90 114 160/110 122 170/110 124 160/110 120 150/100 122
13 24/F 02271 120/80 94 120/90 96 140/100 102 140/100 110 144/100 112 140/90 110
14 24/F 22711 110/70 112 110/80 114 140/90 112 140/100 110 140/100 100 140/100 102
14
15 24/F 28428 110/80 98 114/80 100 140/100 114 144/100 120 140/90 116 140/86 112
16 33/M 36185 120/90 110 124/88 112 150/100 116 144/96 120 144/90 114 140/88 110
17 15/M 03887 110/70 88 110/70 92 136/98 108 140/98 110 140/90 112 128/88 98
18 23/F 35647 130/90 90 130/90 90 144/90 100 140/100 102 140/90 98 128/88 96
19 21/F 36790 100/70 88 110/70 92 150/90 108 144/90 112 140/90 112 130/86 98
20 27/M 38698 120/80 78 120/82 78 138/90 96 144/90 98 144/90 96 130/88 88
21 21/M 41212 120/70 88 120/80 84 144/98 96 150/100 102 150/98 100 130/90 98
22 36/M 41641 120/90 100 120/90 102 140/100 114 150/110 118 150/110 118 140/100 110
23 26/F 43460 100/60 88 100/60 86 130/100 100 134/100 102 130/90 102 130/86 96
24 22/F 42927 130/90 88 130/90 88 144/100 98 150/100 100 150/90 98 140/90 96
15
25 29/M 43806 100/60 88 100/60 90 130/90 108 136/90 110 130/90 98 126/88 98
26 31/M 43117 110/80 90 110/80 92 130/100 114 130/100 116 130/90 108 130/84 98
27 30/M 29736 110/70 86 100/70 88 140/94 98 144/90 100 140/90 98 130/90 96
28 24/F 22711 120/70 98 120/70 100 144/90 122 140/100 120 140/90 110 130/90 110
29 30/F 28180 130/80 88 130/80 88 150/100 112 150/100 112 144/100 108 140/90 100
30 16/F 22138 100/70 96 100/80 90 130/100 102 136/100 112 130/96 106 130/90 98

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CONTROL GROUP
CASE AGE/IP baseline 1MIN ECT 1MIN 3min 5min 10min
1 24/F 2271 120/80 94 120/80 92 170/110 130 180/110 132 170/100 126 160/100 122
2 26/F 25384 130/80 96 130/80 96 170/110 140 170/110 144 160/110 138 150/110 128
3 30/M 29726 140/80 88 140/90 92 190/120 126 180/110 136 170/120 132 160/110 128
4 22/M 38873 130/70 112 130/80 114 200/120 138 190/120 144 190/110140 170/110 126
5 20/M 25250 110/80 102 120/88 108 180/120 132 170/120 136 170/100 122 150/110 120
17
06 21/M 26450 120/80 90 120/80 90 170/120 140 180/120 152 160/110 130 150/110 124
07 30/F 28120 110/80 82 110/80 84 160/110 144 170/120 140 160/110/126 160/90 118
08 16/F 22138 130/80 88 130/80 86 170/100 122 170/110 132 160/100 130 150/100 120
09 24/F 28428 120/70 76 120/70 74 170/100 104 170/100 114 170/90 104 150/90 98
10 22/M 38873 100/70 80 100/70 78 150/100 98 160/110 108 150/100 102 140/100 98
11 15/M 3887 110/70 78 110/70 80 170/120 122 170/120 120 160/110 110 150/110 108
12 33/M 36185 130/80 88 130/80 90 180/130 134 170/120 124 160/120 120 160/110 108
13 23/F 35647 120/70 94 120/80 90 170/110 146 170/110 134 170/100 122 150/90 112
14 21/F 36790 110/80 88 110/80 86 160/110 124 170/110 130 160/100 120 150/90 100
18
15 36/M 41641 120/80 90 120/90 90 160/110 130 160/100 126 150/100 108 146/100 110
16 21/M 41212 110/80 78 110/80 80 180/100 108 170/110 110 170/100 112 160/90 98
17 20/F 40902 120/70 72 120/70 70 150/100 112 160/110 100 160/100 110 150/100 100
18 26/F 43460 100/60 68 100/60 68 150/110 102 150/100 100 148/90 102 140/90 90
19 22/M 42927 110/70 86 110/70/ 88 160/110 98 170/98 108 170/100 110 160/90 100
20 29/M 43806 130/90 90 130/90 92 180/110 112 170/110 114 160/100 106 150/100 100
21 31/F 43117 100/70 72 100/70 72 150/110 102 160/110 112 160/110 110 140/100 108
22 17/F 40067 120/80 78 120/80 88 160/120 114 160/120 116 150/100 100 150/100 98
23 23/F 35646 130/90 78 130/90 78 170/120 114 170/110 112 160/100 80 140/90 78
24 33/M 36185 110/80 78 110/80 80 150/100 102 150/90 100 150/90 98 140/90 94
19
25 43/M 38699 100/60 76 100/60 78 160/100 102 160/110 104 150/100 100 140/90 90
26 36/M 44990 120/70 88 120/70 90 160/120/122 160/120 120 160/110 110 150/100 100
27 26/F 43460 120/70 68 120/70 70 170/110 110 170/110 108 160/100 108 160/90 98
28 29/M 43860 130/80 88 130/80 86 180/100 124 170/120 120 170/120 112 158/100 102
29 31/F 43112 130/80 80 130/80 84 170/120 118 170/110 118 150/90 100 150/90 98
30 22/M 42927 100/80 80 100/80 80 160/110 130 160/100 126 160/100 122 160/90 90
20

• RESULTS ANALYSIS.

21
SYSTOLIC BLOOD PRESSURE
22
RISE IN SYSTOLIC BLOOD PRESSURE
23
DIASTOLIC BLOOD PRESSURE
24
RISE IN DIASTOLIC BLOOD PRESSURE
25
HEART RATE
26
RISE IN HEART RATE
27
SYSTOLIC BLOOD PRESSURE AT LABETALOL GROUP CONTROL GROUP p
Base line 118.7 12 117.7 11.4 0.7487 Not significant
After 1 minute (before ECT) 119.6 12.5 118 11.3 0.595 Not significant
1 minute after ECT 140.9 11.7 167.3 12.3 0.0001 Significant
3 minutes after ECT 143.2 11.7 167.7 8.6 0.0001 Significant
5 minutes after ECT 141.5 11.3 161.3 9.1 0.0001 Significant
10 minutes after ECT 135.3 9.9 151.5 7.9 0.0001 Significant
28
DIASTOLIC BLOOD PRESSURE AT LABETALOL GROUP CONTROL GROUP p
Base line 79.0 10.3 76 7.2 0.1858 Not significant
After 1 minute (before ECT) 80.5 12.5 77.6 8.1 0.1233 Not significant
1 minute after ECT 97.0 7.8 111 8.4 0.0001 Significant
3 minutes after ECT 97.6 8.7 110.6 8 0.0001 Significant
5 minutes after ECT 95 10.6 103 8.4 0.0013 Significant
10 minutes after ECT 90.6 6.8 98 8.1 0.0002 Significant
29
HEART RATE AT LABETALOL GROUP CONTROL GROUP p
Base line 94.5 9.3 90.2 8.8 0.1856 Not significant
After 1 minute (before ECT) 96 11.2 91.1 9.3 0.1722 Not significant
1 minute after ECT 107.6 10.0 120 14.5 0.0007 Significant
3 minutes after ECT 110.5 9.4 121.3 14.3 0.0051 Significant
5 minutes after ECT 107.4 9.1 115.7 12.1 0.0087 Significant
10 minutes after ECT 103.1 8.4 112.5 9.1 0.0006 Significant
30
CONCLUSION

• Labetolol when given in a dosage of 0.25 mg/Kg
  body weight does DECREASE the STRESS RESPONSE in
  Modified ECT.
• (Statistical analysis was done
  chi-square test)