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J Thorac Cardiovasc Surg 1998;115:890-897
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Esmolol for the management of pediatric hypertension after cardiac operations

From the Departments of Pharmaceutical Sciences,^a Pharmacy Practice,^b and Cardiothoracic Surgery,^c Medical University of South Carolina, Charleston, S.C.

Received for publication May 15, 1997. Revisions requested July 29, 1997; revisions received August 28, 1997. Accepted for publication Oct. 7, 1997. Address for reprints: Donald B. Wiest, PharmD, Medical University of South Carolina, Department of Pharmaceutical Sciences, QF 220, 171 Ashley Ave., Charleston, SC 29425.

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 ß-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 µg/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: The dosage required to control hypertension in patients after repair of aortic coarctation was higher than patients who underwent repair of other congenital heart defects. Esmolol was effective in controlling blood pressure in 19 of 20 patients without adverse effects. (J Thorac Cardiovasc Surg 1998;115:890-7)

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