title: Clevidipine for perioperative blood pressure control in infants and children undergoing cardiac surgery for congenital heart disease.
abstract: OBJECTIVE
  To determine the efficacy and adverse effect profile of clevidipine when used for perioperative blood pressure (BP) control during surgery for congenital heart disease (CHD).
  
  
  METHODS
  We retrospectively reviewed our experience with the perioperative use of clevidipine in pediatric-aged patients undergoing surgery for CHD.
  
  
  RESULTS
  The study cohort included 14 patients ranging from 11 months to 15 years (7.4 ± 4.6 years) and weighing from 5 to 41 kg (21.8 ± 11.1 kg). Clevidipine was administered as a continuous infusion for control of either postoperative BP or intraoperative mean arterial pressure (MAP) during cooling and cardiopulmonary bypass (CPB). It was administered as a bolus for BP control during emergence from anesthesia following cardiac surgery. The continuous infusion was started at 1 mcg/kg/min and increased in increments of 0.5 to 1 mcg/kg/min as needed. For postoperative BP control, dosing requirements varied from 1 to 7 mcg/kg/min (mean = 2.0 ± 1.2 mcg/kg/min). The target BP was achieved within 5 minutes in all patients. Two patients were treated with intravenous or oral propranolol for an increase in heart rate (HR) while receiving clevidipine. Despite doses up to 10 mcg/kg/min, effective control of MAP could not be achieved during CPB and cooling (core body temperature 28°C to 32°C). Bolus doses of clevidipine (10 to 15 mcg/kg) controlled BP during emergence from anesthesia with a decrease of the MAP from 97 ± 6 mm Hg to 71 ± 5 mm Hg (p<0.01).
  
  
  CONCLUSIONS
  Clevidipine is effective for perioperative BP control in infants and children with CHD; however, it does not appear effective in controlling MAP during cooling and CPB.
authors.affiliation: Departments of Anesthesiology and Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.forename: William S
authors.initials: WS
authors.lastname: Schechter
authors.forename: Alistair
authors.initials: A
authors.lastname: Phillips
authors.forename: Samuel
authors.initials: S
authors.lastname: Weinstein
authors.forename: Robert
authors.initials: R
authors.lastname: Michler
authors.forename: John W
authors.initials: JW
authors.lastname: Berkenbosch
authors.forename: Carlos
authors.initials: C
authors.lastname: Montoya