An Equivalence Trial Comparing Labetalol and
Diltiazem in Controlling Emergence Hypertension
after Supratentorial Tumor Surgery
Busara Sirivanasandha MD*,
Arerat Sakaew MD*, Kulwadee Sutthivaiyakit MD*, Kasana Raksamani MD*,
Pichaya Waitayawinyu MD*, Pranee Rushatamukayanunt MD*, Walaiporn Punkla MD*
Affiliation :
* Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Hypertension and tachycardia during emergence from anesthesia for craniotomy could increase risks of
cerebral complications. Several anesthetic, sedative, and antihypertensive drugs have been suggested that may be successful
at suppressing these unwanted hemodynamic consequences.
Objective : To study the equivalent efficacy and side effects of two antihypertensive drugs, diltiazem and labetalol.
Material and Method: A block randomized control trial was performed in 184 patients who developed emergence hypertensive
response after craniotomy for supratentorial tumor removal. Systolic blood pressure (SBP) of each patient was suppressed
by 2.5 mg of study drugs and repeated with fix dosage of 2.5 mg every two to three minutes to maintain SBP lower than
140 mmHg with a cumulative dose within 20 mg. Data regarding demographic, successful rate in controlling hypertension,
drug dosage, and incidence of side effects were analyzed.
Results : The success rate of treatment of labetalol was equivalent to diltiazem (87.1% and 80.2% respectively) [p = 0.003,
95% CI = 6.88 (-2.06 to 15.8)]. There was no statistical significant difference on dosage of drugs used or incidence of side
effect (hypotension, bradycardia, heart block, and bronchospasm). Median (minimum-maximum) dosage of labetalol and
diltiazem were 10 mg (2.5-20 mg) and 10 mg (2.5-20 mg) respectively. The expense for labetalol was 1/6 of diltiazem.
Conclusion : Labetalol has equivalent efficacy to diltiazem. Both drugs used low median dosage giving low incidence of
side-effects. Labetalol is a good alternative drug to control hypertensive response during emergence from anesthesia for
post-craniotomy.
Keywords : Labetalol, Diltiazem, Emergence hypertension, Craniotomy
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