title: Nicardipine for Hypertension Following Aortic Coarctectomy or Superior Cavopulmonary Anastomosis.
abstract: BACKGROUND
  Literature on the use of nicardipine, a dihydropyridine calcium channel antagonist, in children recovering from cardiac surgery is sparse and, to our knowledge, nonexistent in children with single ventricle anatomy. We aimed to report our experience with nicardipine in these patient populations.
  
  
  METHODS
  We performed a retrospective review of children recovering from aortic coarctectomy or superior cavopulmonary anastomoses who received nicardipine for hypertension at our institution between 2007 and 2013. Hemodynamic variables prior to and after nicardipine initiation were compared using paired t tests.
  
  
  RESULTS
  Seven children recovering from aortic coarctectomy (median age 8.6 months, range: 1.5 months-7.9 years) and four children recovering from superior cavopulmonary anastomosis (median age: seven months, range: five-nine months) were reviewed. For all patients, at six hours after initiation of nicardipine, mean systolic blood pressure was significantly decreased, 123 ± 19 versus 103 ± 14 mm Hg (P = .001), as were diastolic blood pressure, 68 ± 20 versus 53.5 ± 10 mm Hg (P = .041), and sodium nitroprusside dose, 4.3 ± 2.9 versus 1.3 ± 1.7 mcg/kg/min (P = .002). Further, within 24 hours, serum lactate decreased from 1.45 ± 0.82 to 0.81 ± 0.29 mg/dL (P = .016). Heart rate, blood urea nitrogen, and serum creatinine measurements were statistically unchanged.
  
  
  CONCLUSIONS
  Nicardipine effectively decreased blood pressure without apparent adverse events in a small cohort of children with postoperative hypertension while recovering from aortic coarctectomy or superior cavopulmonary anastomosis. Further research comparing nicardipine to more conventional titratable antihypertensive agents in these patient populations is warranted.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Riley Hospital of Children, in affiliation with Indiana University, Indianapolis, IN, USA cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, in affiliation with Wayne State University, Detroit, MI, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Arango Uribe
mesh_terms: D001017:Aortic Coarctation / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009529:Nicardipine / Q000008:administration & dosage*; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine
keywords: cavopulmonary anastomosis; coarctation; hypertension; nicardipine; postoperative care