Abstract | OBJECTIVE:
Hypertension frequently occurs during the immediate postoperative period in children after repair of aortic coarctation but may also occur after repair of other congenital heart defects. Nitroprusside has often been used to control blood pressure in this setting. Because hypertension after coarctation repair is frequently associated with elevations in catecholamines, esmolol, a short-acting beta-blocking agent, may be an effective alternative. Therefore we undertook the first systematic investigation to determine the efficacy and disposition of esmolol in pediatric patients with acute hypertension after cardiac operations. METHODS: Twenty patients aged 1 month to 12 years (median 25.6 months) with acute hypertension after cardiac operations received esmolol in an opened-labeled trial. Esmolol was titrated to a blood pressure less than or equal to the 90th percentile for age. RESULTS: Ten 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 microg/kg/min) there was a significant percent decrease in heart rate and systolic and diastolic blood pressures from postoperative values. Esmolol dose was significantly associated with percent reduction in systolic blood pressure. Final esmolol dose and total body clearance were significantly higher in patients after coarctation repair. There were significant associations between esmolol dose and esmolol blood concentrations at steady state. CONCLUSIONS:
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Authors | D B Wiest, S S Garner, W E Uber, R M Sade |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 115
Issue 4
Pg. 890-7
(Apr 1998)
ISSN: 0022-5223 [Print] United States |
PMID | 9576226
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Adrenergic beta-Antagonists
- Propanolamines
- esmolol
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Topics |
- Adrenergic beta-Antagonists
(administration & dosage, pharmacokinetics, therapeutic use)
- Aortic Coarctation
(surgery)
- Child
- Child, Preschool
- Dose-Response Relationship, Drug
- Female
- Heart Defects, Congenital
(surgery)
- Humans
- Hypertension
(drug therapy, etiology)
- Infant
- Male
- Postoperative Complications
(drug therapy)
- Propanolamines
(administration & dosage, pharmacokinetics, therapeutic use)
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