The Effect of Intraoperative Labetalol on Time to Discharge
Condition: Bloodpressure; Heart Rate
Study type: Interventional
Phase: Phase 2

Summary: 
      Patients coming for surgery often receive opioid medications, like fentanyl, to treat pain.
      Opioids however have many unpleasant side effects including nausea and vomiting, itching,
      sedation, and decreased breathing. During laparoscopic surgery increases in heart and blood
      pressure are often attributed to pain. It has been shown that by treating these changes with
      medications such as esmolol, instead of opioids, side effects and time to discharge from
      hospital can be reduced. Labetalol is a drug that is similar to esmolol but may have
      advantages over it. It is more effective at controlling both heart rate and blood pressure
      and it is easier and less costly to use. This study is investigating labetalol in patients
      having laparoscopic gallbladder surgery and comparing it to esmolol and fentanyl. Patients
      will be treated with one of these drugs during surgery to control heart rate and blood
      pressure and the effects on time to discharge, pain scores, frequency of side effects, and
      narcotic requirements will be observed in the recovery room. It is thought that labetalol
      will be shown to be as effective as esmolol and that both drugs that minimize fentanyl will
      show reduced time to discharge, fewer side effects, and effective treatment of heart rate and
      blood pressure.
    


Intervention name(s): Esmolol; Labetalol; Fentanyl; saline infusion; 1 ml saline infusion
Intervention type(s): Drug; Drug; Drug; Other; Other
Intervention description(s): Following induction and intubation, any increase in heart rate (HR) or mean arterial pressure (MAP) >20% of baseline will be treated with an initial intravenous bolus of esmolol 30 mg IV (30 mg in 5 ml of normal saline). An intravenous esmolol infusion will be initiated at 5mcg/kg/min after the first intravenous bolus dose and will be titrated up by 5mcg/kg/min each time HR or MAP >20% of baseline. An intravenous bolus of placebo (normal saline 1 ml) will be administered whenever a change to the infusion rate is made.; Following induction and intubation, any increase in heart rate (HR) or mean arterial pressure (MAP) >20% of baseline will be treated with an initial intravenous bolus of labetalol 10 mg IV (10 mg in 5 ml of normal saline). Any further increases in HR or MAP >20% of baseline will be treated with intravenous boluses of labetalol 5 mg in 1 ml every 5 minutes as needed. An intravenous placebo infusion (normal saline) will be initiated at 5 mcg/kg/min after the first intravenous bolus dose and will be titrated up by 5 mcg/kg/min each time an additional intravenous bolus is given.; Following induction and intubation, any increase in heart rate (HR) or mean arterial pressure (MAP) >20% of baseline will be treated with an initial intravenous bolus of fentanyl 50 mcg IV (50 mcg in 5 ml of normal saline). Any further increases in HR or MAP >20% of baseline will be treated with intravenous boluses of fentanyl 25 mcg in 1 ml every 5 minutes as needed. An intravenous placebo infusion (normal saline) will be initiated at 5 mcg/kg/min after the first intravenous bolus dose and will be titrated up by 5 mcg/kg/min each time an additional intravenous bolus is given.; An intravenous placebo infusion (normal saline) will be initiated at 5 mcg/kg/min after the first intravenous bolus drug dose (fentanyl or labetalol depending upon randomization) and will be titrated up by 5 mcg/kg/min each time an additional intravenous bolus is given.; Every time the infusion rate of esmolol is changed, 1 ml of normal saline will be infused.
Intervention MeSH terms: Labetalol; Fentanyl; Esmolol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment