Labetalol for hypertension after nasal use of lignocaine with epinephrine

Abstract

A 42 year, 62 kg, ASA I, male patient was scheduled to undergo endoscopic resection of a nonfunctional pituitary macroadenoma. The patient did not have any cardiorespiratory abnormality and the routine hematological investigations and the hormonal profile were within normal limits. Invasive arterial blood pressure (IBP) was 136/81 mmHg and heart rate (HR) 86/min. General anesthesia (GA) was induced with fentanyl (125 mcg) and propofol (120 mg) trachea was intubated with 70 mg rocuronium. We maintained GA with sevoflurane and O_2: N₂O (40:60). Ten minutes after intubation, nasal mucosa was infiltrated with lignocaine 2% with epinephrine 1:200,000 and the nasal cavity was packed with epinephrine (1:200,000) soaked gauge. Few minutes after nasal packing, an increase in IBP to 220/110 and HR to 146 bpm was observed.  We administered labetalol (10+10 mg boluses) causing reduction of IBP to 140/90 but the HR dropped to 30/min. The resultant bradycardia responded to inj atropine 0.6 mg IV.