Pharmacologic Control of Blood Pressure in Infants and Children
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REVIEW ARTICLE
Pharmacologic Control of Blood Pressure in Infants and Children Joseph D. Tobias1 · Aymen Naguib1 · Janet Simsic2 · Catherine D. Krawczeski2 Received: 2 June 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Alterations in blood pressure are common during the perioperative period in infants and children. Perioperative hypertension may be the result of renal failure, volume overload, or activation of the sympathetic nervous system. Concerns regarding end-organ effects or postoperative bleeding may mandate regulation of blood pressure. During the perioperative period, various pharmacologic agents have been used for blood pressure control including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. The following manuscript outlines the commonly used pharmacologic agents for perioperative BP including dosing regimens and adverse effect profiles. Previously published clinical trials are discussed and efficacy in the perioperative period reviewed. Keywords Hypertension · Blood pressure · Sodium nitroprusside · Calcium channel antagonist · β-adrenergic antagonist · Nitroglycerin Abbreviations BP Blood pressure CH Controlled hypotension CHD Congenital heart disease CN Cyanide CNS Central nervous system CPB Cardiopulmonary bypass CV Cardiovascular GMP Guanosine 3′,5′-cyclic monophosphate HPV Hypoxic-pulmonary vasoconstriction HR Heart rate ICP Intracranial pressure ICU Intensive care unit MAP Mean arterial pressure NO Nitric oxide NTG Nitroglycerin SNP Sodium nitroprusside SVR Systemic vascular resistance TBI Traumatic brain injury * Joseph D. Tobias [email protected] 1
Departments of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital and The Ohio State University, 700 Children’s Drive, Columbus, OH 43205, USA
Department of Pediatrics and Division of Pediatric Cardiology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
2
Introduction During the intraoperative and postoperative periods, various factors may lead to hypertension in the pediatric-aged patient including renal failure, volume overload, altered baroreceptor function, or activation of the sympathetic nervous system [1–3]. Perioperative blood pressure (BP) control may be even more problematic and of greater consequence in specific clinical scenarios such as surgery for congenital heart disease (CHD) or patients with intracranial pathology where hypertension may result in excessive bleeding or disruption of suture lines. Once treatable causes of hypertension such as pain, hypercarbia, and hypoxemia are excluded, pharmacologic control of BP may be indicated. In the ambulatory setting, specific guidelines have been provided for BP values that should initiate investigation and treatment [4]. In general, values that consistently (≥ 3 occasions) exceed the upper limit of the 95th percentile for age or are greater than 130/80 mmHg in patients ≥ 13 ye
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