Db. Wiest et al., ESMOLOL FOR THE MANAGEMENT OF PEDIATRIC HYPERTENSION AFTER CARDIAC OPERATIONS, Journal of thoracic and cardiovascular surgery, 115(4), 1998, pp. 890-897
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
.