The Efficacy of Labetalol Infusion Started after Dural Closure in Controlling Extubation Hypertension in Neurosurgery

Background: Hypertension is a common accompaniment during emergence from anesthesia following intracranial neurosurgical procedures and may predispose to development of intracranial hematoma. Management of extubation hypertension in this subset of patients continues to be a challenge for anesthesiologists; labetalol which is a advantageous antihypertensive drug in neuroanesthesia was used to control blood pressure tightly during emergence.Patients and Methods: After a standard anesthetic technique for craniotomy for supratentorial tumors, and by the end of surgery and after dural closure, patients were divided randomly into 2 equal groups with 25 patients in each group, Group B received labetalol infusion in a rate of (0.5mg/kg/hr). Group C received normal saline infusion. The rate of the infusion in both groups was 0.5ml/kg/hr. Nitroglycerine at a dose starting from (1m/kg/min) added if systolic blood pressure exceeded 25% of its preinduction value. Haemodynamic parameters were recorded intra-and postoperatively, number of patients number of patients needing nitroglycerine infusion in each group will be recorded together with total amount infused. And time to extubation.Results: Labetalol 0.5mg/kg/hr started after dural closure had a significant effect in reducing SBP, HR during emergence and extubation. Labetalol reduces the incidence and the extent of extuabation hypertension as the number of patients needing nitroglycerin was 5 representing 20% of patients in labetalol group and 22 representing 88% of patients in control group without significant prolonging the time to emergence.Conclusion: Labetalol 0.5mg/kg/hr started after dural closure had a significant effect in reducing the incidence and the extent of emergence hypertension without prolonging the time needed for extubation.