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

13. 8
22/M
25145
130/90 96 98
150/110
112
150/100
116
140/110
114
140/90
110 9
21/M
26450
120/90
100
102
140/100
120 10
35/F
26988
100/60 88 84
120/80
130/84
130/80 11
20/M
25460
130/100
118
122
150/96 12
30/F
38873
160/110
170/110
124 13
24/F
02271 94
144/100 14
22711
110/70
110/80

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
150/100
144/96
144/90
140/88 17
15/M
03887
110/70 88 92
136/98
108
140/98
128/88 18
23/F
35647
130/90 90
102 96 19
21/F
36790
100/70
150/90
130/86 20
27/M
38698
120/80 78
120/82
138/90
130/88 21
21/M
41212
120/70 84
144/98
150/98 22
36/M
41641
150/110
118 23
26/F
43460
100/60 86
130/100
134/100 24
22/F
42927

15. 25
29/M
43806
100/60 88 90
130/90
108
136/90
110 98
126/88 26
31/M
43117
110/80 92
130/100
114
116
130/84 27
30/M
29736
110/70 86
100/70
140/94
144/90
100
140/90 96 28
24/F
22711
120/70
122
140/100
120 29
30/F
28180
130/80
150/100
112
144/100 30
16/F
22138
100/80
102
136/100
130/96
106

16. CONTROL GROUP… CASE AGE/IP baseline 1MIN ECT 1MIN 3min 5min 10min 1
24/F
2271
120/80 94 92
170/110
130
180/110
132
170/100
126
160/100
122 2
26/F
25384
130/80 96
140
144
160/110
138
150/110
128 3
30/M
29726
140/80 88
140/90
190/120
136
170/120 4
22/M
38873
130/70
112
114
200/120
190/110140 5
20/M
25250
110/80
102
120/88
108
180/120
120

17. 06
21/M
26450
120/80 90
170/120
140
180/120
152
160/110
130
150/110
124 07
30/F
28120
110/80 82 84
144
160/110/126
160/90
118 08
16/F
22138
130/80 88 86
170/100
122
170/110
132
160/100
150/100
120 09
24/F
28428
120/70 76 74
104
114
170/90
150/90 98 10
22/M
38873
100/70 80 78
108
102
140/100 11
15/M
3887
110/70
110 12
33/M
36185
180/130
134
160/120 13
23/F
35647 94
146
112 14
21/F
36790
100

18. 15
36/M
41641
120/80 90
120/90
160/110
130
160/100
126
150/100
108
146/100
110 16
21/M
41212
110/80 78 80
180/100
170/110
170/100
112
160/90 98 17
20/F
40902
120/70 72 70
100 18
26/F 43460
100/60 68
150/110
102
148/90
140/90 19
22/M
42927
110/70 86
110/70/ 88
170/98 20
29/M 43806
130/90 92
180/110
114
106 21
31/F
43117
100/70
140/100 22
17/F
40067
160/120
116 23
23/F
35646
170/120 24
33/M
36185
150/90 94

19. 25
43/M
38699
100/60 76 78
160/100
102
160/110
104
150/100
100
140/90 90 26
36/M
44990
120/70 88
160/120/122
160/120
120
110 27
26/F
43460 68 70
170/110
108
160/90 98 28
29/M
43860
130/80 86
180/100
124
170/120
112
158/100 29
31/F
43112 80 84
118
150/90 30
22/M 42927
100/80
130
126
122

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)
0.595 Not significant
1 minute after ECT
Significant
3 minutes after ECT
5 minutes after ECT
10 minutes after ECT

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
5 minutes after ECT
Significant
10 minutes after ECT
Significant

29. After 1 minute (before ECT)
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)