ESMOLOL FOR THE MANAGEMENT OF PEDIATRIC HYPERTENSION AFTER CARDIAC OPERATIONS

Objective: Hypertension frequently occurs during the immediate postope rative period in children after repair of aortic coarctation but may a lso occur after repair of other congenital heart defects. Nitroprussid e has often been used to control blood pressure in this setting. Becau se hypertension after coarctation repair is frequently associated with elevations in catecholamines, esmolol, a short-acting beta-blocking a gent, may be an effective alternative. Therefore me undertook the firs t systematic investigation to determine the efficacy and disposition o f esmolol in pediatric patients with acute hypertension after cardiac operations. Methods: Twenty patients aged 1 month to 12 years (median 25.6 months),vith acute hypertension after cardiac operations received esmolol in an opened-labeled trial. Esmolol was titrated to a blood p ressure less than or equal to the 90th percentile for age. Results: Te n patients had coarctation repair and the remaining patients underwent repair of other congenital heart defects. On final esmolol dose (mean +/- standard deviation dosage 700 +/- 232 mu g/kg/min) there was a si gnificant percent decrease in heart rate and systolic and diastolic bl ood pressures from postoperative values. Esmolol dose was significantl y associated with percent reduction in systolic blood pressure. Final esmolol dose and total body clearance were significantly higher in pat ients after coarctation repair. There were significant associations be tween esmolol dose and esmolol blood concentrations at steady state. C onclusions: The dosage required to control hypertension in patients af ter repair of aortic coarctation was higher than patients who underwen t repair of other congenital heart defects. Esmolol was effective in c ontrolling blood pressure in 19 of 20 patients without adverse effects .