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Esmolol for the management of pediatric hypertension after cardiac operations

D B Wiest1, S S Garner, W E Uber

  • 1Department of Pharmaceutical Sciences, Medical University of South Carolina, Charleston 29425, USA.

The Journal of Thoracic and Cardiovascular Surgery
|May 12, 1998
PubMed

Insights

Esmolol effectively controlled postoperative hypertension in pediatric cardiac surgery patients. Higher doses were needed for aortic coarctation repair compared to other congenital heart defect repairs.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Postoperative hypertension is common in children following aortic coarctation repair and other congenital heart defect surgeries.
  • Elevated catecholamines often contribute to hypertension post-coarctation repair, suggesting beta-blockers as a potential treatment.
  • Nitroprusside has been a traditional treatment, but esmolol offers a potential alternative.

Purpose of the Study:

  • To investigate the efficacy and disposition of esmolol for acute hypertension in pediatric patients after cardiac operations.
  • To compare esmolol's effectiveness in patients with aortic coarctation repair versus other congenital heart defect repairs.

Main Methods:

  • An open-label trial involving 20 pediatric patients (1 month to 12 years) with postoperative hypertension.
  • Esmolol was administered and titrated to maintain blood pressure at or below the 90th percentile for age.

Main Results:

  • Esmolol significantly reduced heart rate and blood pressure in pediatric patients post-cardiac surgery.
  • A higher esmolol dosage and clearance were observed in patients after aortic coarctation repair.
  • Esmolol dose correlated with the percentage reduction in systolic blood pressure and steady-state concentrations.

Conclusions:

  • Esmolol effectively controlled hypertension in 19 out of 20 pediatric patients without adverse effects.
  • Patients undergoing aortic coarctation repair required higher esmolol doses than those with other congenital heart defect repairs.
Abstract

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