Use of Nicardipine After Cardiac Operations Is Safe in Children Regardless of Age

Stone, Matthew L.; Kelly, John; Mistry, Maanasi; Buck, Marcia L.; Gangemi, James J.; Vergales, Jeffrey

doi:10.1016/j.athoracsur.2017.05.035

Cited by 15 publications

(15 citation statements)

References 21 publications

(22 reference statements)

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“…Stone et al published their experience with nicardipine for postoperative BP control in 68 children following cardiac surgery. 5 Thirty-three patients were <6 months of age and 35 were >6 months. Their study did include some neonates undergoing surgery but no neonates with single ventricle physiology.…”

Section: Discussionmentioning

confidence: 99%

“…Scattered reports of nicardipine use in neonates and infants have not included neonates undergoing single ventricle palliation. 4,5…”

Section: Introductionmentioning

confidence: 99%

“…Scattered reports of nicardipine use in neonates and infants have not included neonates undergoing single ventricle palliation. 4,5 In 2017, our program switched to nicardipine as the first-line antihypertensive for all postoperative patients regardless of age or diagnosis. This practice change was driven primarily by medication cost issues.…”

Section: Introductionmentioning

confidence: 99%

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Nicardipine Is a Safe, Efficacious, and Cost-Effective Antihypertensive for Neonates and Young Infants Undergoing Cardiac Surgery

Lushaj

Hermsen

Nelson

et al. 2022

World J Pediatr Congenit Heart Surg

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Objective The use of nicardipine in congenital cardiac surgery has been guarded given the calcium sensitivity of immature myocardium and paucity of clinical data. Reports of nicardipine use have excluded neonates with single ventricles. The goal of this study was to compare the use of nicardipine and sodium nitroprusside for postoperative blood pressure control in young patients recovering from cardiac surgery. Methods All neonates (<30 days) and young infants (31-180 days) who received either sodium nitroprusside or nicardipine as first-line therapy for blood pressure control were retrospectively reviewed. Some patients had multiple index operations and each index operation was counted separately regarding treatment with sodium nitroprusside or nicardipine. Results A total of 59 patients underwent 70 procedures (24 as neonates and 46 as infants). Nicardipine was administered as initial therapy following 33 procedures (n = 28 patients), and sodium nitroprusside was administered as initial therapy following 37 index procedures (n = 31 patients). The duration of treatment was longer ( P = .025) when sodium nitroprusside was the initial treatment. Five (15%) patients that received nicardipine required a second blood pressure management agent, and seven (19%) patients that received sodium nitroprusside required a second agent ( P = .66). No adverse events related to titratable antihypertensive therapy were recorded in any treatment group. The use of nicardipine resulted in significant medication cost reduction. Based on average wholesale price, patient costs for sodium nitroprusside use were $182,952 ($5,544/pt), while costs for nicardipine were only $24,960 ($780/pt). Conclusions Nicardipine can be safely used as a first-line antihypertensive in infants. The use of nicardipine as initial antihypertensive therapy rather than sodium nitroprusside can lead to a significant reduction in medication costs without jeopardizing clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Scattered reports of nicardipine use in neonates and infants have not included neonates undergoing single ventricle palliation. 4,5…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nicardipine Is a Safe, Efficacious, and Cost-Effective Antihypertensive for Neonates and Young Infants Undergoing Cardiac Surgery

Lushaj

Hermsen

Nelson

et al. 2022

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

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“…Similarly, the nitro-vasodilator nitroglycerine activates cGMP leading to vasodilation of the systemic arterioles and venules. However, due to its preferential effects on the venodilatory properties, it has been found to be less effective in vasodilation compared to nitroprusside [20] . The selective calcium channel blocker nicardipine has also been found to be safe and effective when treating postoperative systemic hypertension, even in children < 6 months of age [21] .…”

Section: Systemic Vasodilatorsmentioning

confidence: 99%

Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use

Sahulee¹,

McKinstry²

2022

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The low cardiac output syndrome describes the phenomenon of the reduction of cardiac output that can occur following cardiac surgery requiring cardiopulmonary bypass. If unrecognized or untreated, this condition can result in significant morbidity and mortality. Along with non-pharmacologic therapies, pharmacologic agents used to help manage the low cardiac output syndrome include catecholamine inotropes, inodilators, systemic vasodilators, pulmonary vasodilators, and other classes of medications. We summarize the rationale and key evidence supporting the use of these therapies in children. In addition, utilizing provider surveys and registry reviews, we describe the current trends in the use of these medications and the variation demonstrated between providers and centers. Given the heterogeneous etiology of low cardiac output syndrome, successful management requires that pharmacologic therapies be tailored to the physiologic derangements of each patient.

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“…There were a total of 5 studies of systemic vasodilators that met inclusion criteria and included 399 children. 49,50,[62][63][64] All studies were single centre. Four studies were retrospective cohort studies, and one study was a prospective observational study.…”

Section: Systemic Vasodilatorsmentioning

confidence: 99%

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

et al. 2021

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Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

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Use of Nicardipine After Cardiac Operations Is Safe in Children Regardless of Age

Abstract: Nicardipine is well tolerated after cardiac operations in children irrespective of age or underlying pathology. Thus, nicardipine should be considered as safe and effective in children of all ages for control of hypertension after cardiac operations.

Cited by 15 publications

References 21 publications

Nicardipine Is a Safe, Efficacious, and Cost-Effective Antihypertensive for Neonates and Young Infants Undergoing Cardiac Surgery

Nicardipine Is a Safe, Efficacious, and Cost-Effective Antihypertensive for Neonates and Young Infants Undergoing Cardiac Surgery

Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

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