Labetalol (Trandate) is one of my favorite anti-hypertensive medications in the perioperative and ICU settings! It’s a “mixed” beta blocker courtesy of dual alpha and beta adrenergic antagonism conferred by different stereoisomers of the drug in the traditional racemic formulation. The beta blockade to alpha blockade ratio is often cited as 3:1, but in any case, I consider it a better “blood pressure medication” than the pure beta blockers like metoprolol.

Because of this dual, adrenergic mechanism, labetalol has been used safely in pregnancy, the elderly, renal disease, and in patients with catecholamine crises (cocaine, pheochromocytoma). I frequently titrate 10-20 mg of IV labetalol around the emergence from general anesthesia in patients where increased myocardial oxygen consumption and/or increased systemic blood pressures can be detrimental (ie, coronary artery disease, fresh vascular anastamoses, etc.)

Labetalol tends to preserve cardiac output and stroke volume while decreasing afterload – hemodynamic goals that make it very suitable for patients with coronary artery disease. When VERY tight blood pressure control is needed, I’ll still use titratable agents like nicardipine (Cardene), but labetalol is a great option for blood pressure control in most generic cases.

Drop me comments with questions below! 🙂

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