Clevidipine for Perioperative Blood Pressure Control in Infants and Children

Abstract

Various pharmacologic agents have been used for perioperative BP control in pediatric patients, including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. Of the calcium antagonists, the majority of the clinical experience remains with the dihydropyridine nicardipine. Clevidipine is a short-acting, intravenous calcium channel antagonist of the dihydropyridine class. It undergoes rapid metabolism by non-specific blood and tissue esterases with a half-life of less than 1 minute. As a dihydropyridine, its cellular and end-organ effects parallel those of nicardipine. The clevidipine trials in the adult population have demonstrated efficacy in rapidly controlling BP in various clinical scenarios with a favorable adverse effect profile similar to nicardipine. Data from large clinical trials regarding the safety and efficacy of clevidipine in children is lacking. This manuscript aims to review the commonly used pharmacologic agents for perioperative BP control in children, discuss the role of calcium channel antagonists such as nicardipine, and outline the preliminary data regarding clevidipine in the pediatric population.

Clevidipine for Controlled Hypotension During Spinal Surgery in Adolescents

“…8,9 The first study outlined the use of clevidipine preoperatively, intraoperatively, and postoperatively in doses ranging from 0.5 to 3.5 mg/kg/min in a cohort of 10 patients, ranging in age from 9 to 18 years. 8,9 The first study outlined the use of clevidipine preoperatively, intraoperatively, and postoperatively in doses ranging from 0.5 to 3.5 mg/kg/min in a cohort of 10 patients, ranging in age from 9 to 18 years.…”

“…9 Clevidipine was administered as either a continuous infusion or as a bolus dose. 9 Clevidipine was administered as either a continuous infusion or as a bolus dose.…”

“…No episodes of excessive hypotension were noted. 8,9 We present our initial experience with clevidipine for CH during spinal surgery in adolescents. V arious techniques have been suggested as a means of limiting or avoiding the need for homologous blood transfusions.…”

Therapy of Acute Hypertension in Hospitalized Children and Adolescents

“…It undergoes rapid metabolism by non-specific blood and tissue esterases, and therefore no dosing adjustment is required in those with renal or hepatic impairment [21]. Adult trials have demonstrated its efficacy in rapidly controlling BP in various clinical settings with a favorable adverse effect profile [22]. Because it is prepared in a lipid solution, it is contraindicated in those with egg and soy allergy as well as those with lipid disorders [3, 23].…”

“…Because it is prepared in a lipid solution, it is contraindicated in those with egg and soy allergy as well as those with lipid disorders [3, 23]. One retrospective report included 14 pediatric patients, 11 months to 15 years old, undergoing surgery for congenital heart disease [24]. In 6 patients, it was administered as a continuous infusion for postoperative HTN; in 5 patients, a bolus dose for HTN during emergence from anesthesia; in 3 patients, it was given as continuous infusion for intraoperative BP control during cooling and cardiopulmonary bypass.…”