Hypertensive Meds

Labetalol:
blocks ₁-, ₁-, and ₂-receptors. The ratio of -blockade to -blockade has been estimated to be approximately 1:7. Reduction in BP w/o change in HR or CO. Onset 5 min, halflife 5 hours

B-blockers:
Atenolol excreted unchanged by kidney. Metoprolol, propranolol, labetalol have hepatic metabolism. Esmolol is metabolized by RBC esterases.
Esmolol has half life of 9min

POISE trial
8000 patients with CAD received metoprolol XL before surgery continued for 30 days. Decreased MI but increased mortality and stroke.

Pheo:
Avoid sux as abdominal fasciculates could release catecholamines. Ketamine should be avoided as it is sympathomimetic. Halothine potentiates dysrhythmias of epineprhine. Histamine release provokes catecholamines so no atracurium. Neuroaxial techniques block postganglionic discharge of catecholamines but do not block receptors so pheo still active. Chronic elevations of catecholamines can lead to cerebral hemorrhage, renal failure, heart failure, MI, dysrhythmias.