Abstract
Various pharmacologic agents have been used for perioperative BP control in pediatric patients, including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. Of the calcium antagonists, the majority of the clinical experience remains with the dihydropyridine nicardipine. Clevidipine is a short-acting, intravenous calcium channel antagonist of the dihydropyridine class. It undergoes rapid metabolism by non-specific blood and tissue esterases with a half-life of less than 1 minute. As a dihydropyridine, its cellular and end-organ effects parallel those of nicardipine. The clevidipine trials in the adult population have demonstrated efficacy in rapidly controlling BP in various clinical scenarios with a favorable adverse effect profile similar to nicardipine. Data from large clinical trials regarding the safety and efficacy of clevidipine in children is lacking. This manuscript aims to review the commonly used pharmacologic agents for perioperative BP control in children, discuss the role of calcium channel antagonists such as nicardipine, and outline the preliminary data regarding clevidipine in the pediatric population.
Highlights
Various factors may result in perioperative hypertension in the pediatric-aged patient including renal failure or insufficiency, volume overload, or activation of the sympathetic nervous system [1,2,3].Perioperative blood pressure (BP) control may be even more problematic and of greater consequence in specific clinical scenarios such as surgery for congenital heart disease (CHD) or patients with intracranial pathology where hypertension may result in excessive bleeding or disruption of suture lines
The shorter half-life of esmolol allows it to be titrated by intravenous infusion with tighter heart rate (HR) and BP control than can be achieved with intermittent bolus doses of other agents such as labetalol, propranolol or metoprolol
When compared with sodium nitroprusside (SNP), nitroglycerin or nicardipine for the treatment of acute hypertension in adult cardiac surgery patients, BP control was more effective with clevidipine when compared with nitroglycerin (p = 0.0006) or SNP (p = 0.003) [50]
Summary
Various factors may result in perioperative hypertension in the pediatric-aged patient including renal failure or insufficiency, volume overload, or activation of the sympathetic nervous system [1,2,3]. There are several options for rapid BP control in infants and children including sodium nitroprusside (SNP), nitroglycerin (NTG), labetalol, fenoldopam, and calcium channel antagonists, including nicardipine [3,4,5]. This manuscript reviews the commonly used pharmacologic agents for perioperative BP control in children, discusses the role of calcium channel antagonists such as nicardipine, and outlines the preliminary data regarding clevidipine in the pediatric population
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