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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:

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Presentation on theme: "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:"— Presentation transcript:

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 I&II

7 Exclusion criteria:ASA III &IV Heart Block >I st degree Heart Rate < 50/min Systolic Bp < 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 RESULTS…LABETALOL GROUP CASEAge/IPbaselin e 1minect1MI N 3MIN5MIN10MIN 120/M /80, / / / / / /F / / / / / / /F / / / / / / /M / / / / / / /M / / / / / / /F / / / / / / /M / / / / / /96 104

13 822/M / / / / / / /M / / / / / / /F / / / / / / /M / / / / / / /F / / / / / / /F / / / / / / /F / / / / / /

14 1524/F / / / / / / /M / / / / / / /M / / / / / / /F / / / / / / /F / / / / / / /M / / / / / / /M / / / / / / /M / / / / / / /F / / / / / / /F / / / / / /90 96

15 2529/M / / / / / / /M / / / / / / /M / / / / / / /F / / / / / / /F / / / / / / /F / / / / / /90 98

16 CONTROL GROUP… CASEAGE/IPbaselin e 1MINECT 1MIN 3min5min10min 124/F / / / / / / /F / / / / / / /M / / / / / / /M / / / / / / /M / / / / / /

17 0621/M / / / / / / /F / / / / /110/ / /F / / / / / / /F / / / / / / /M / / / / / / /M / / / / / / /M / / / / / / /F / / / / / / /F / / / / / /90 100

18 1536/M / / / / / / /M / / / / / / /F / / / / / / /F / / / / / / /M / /70/ / / / / /M / / / / / / /F / / / / / / /F / / / / / / /F / / / / / / /M / / / / / /90 94

19 2543/M / / / / / / /M / / /120 / / / / /F / / / / / / /M / / / / / / /F / / / / / / /M / / / / / /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 Not significant After 1 minute (before ECT) Not significant 1 minute after ECT Significant 3 minutes after ECT Significant 5 minutes after ECT Significant 10 minutes after ECT Significant

28 DIASTOLIC BLOOD PRESSURE AT LABETALOL GROUP CONTROL GROUP p Base line Not significant After 1 minute (before ECT) Not significant 1 minute after ECT Significant 3 minutes after ECT Significant 5 minutes after ECT Significant 10 minutes after ECT Significant

29 HEART RATE AT LABETALOL GROUP CONTROL GROUP p Base line Not significant After 1 minute (before ECT) Not significant 1 minute after ECT Significant 3 minutes after ECT Significant 5 minutes after ECT Significant 10 minutes after ECT 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)


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