Use of dexmedetomidine as an adjunct in the treatment of paradoxical hypertension after surgical repair of coarctation of the aorta in infants

Sahu, Manoj Kumar; Manikala, Vinod K; Singh, Sarvesh Pal; Bisoi, AK; Chowdhury, Ujjwal K.

doi:10.4103/0971-9784.159826

Cited by 4 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sahu et al . [ 15 ] documented that dexmedetomidine is a safe drug and used as an adjunct for nitroglycerin and nitroprusside in the management of severe paradoxical hypertension. The paradoxical hypertension was severe and not controlled well by nitroglycerin and nitroprusside in the immediate postoperative period in two cases of aortic coarctation repair.…”

Section: Discussionmentioning

confidence: 99%

Assessment the effect of dexmedetomidine on incidence of paradoxical hypertension after surgical repair of aortic coarctation in pediatric patients

Soliman

Saad

2018

Ann Card Anaesth

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Assessment the effect of dexmedetomidine on incidence of paradoxical hypertension after surgical repair of aortic coarctation in pediatric patients

Soliman

Saad

2018

Ann Card Anaesth

View full text Add to dashboard Cite

“…Dexmedetomidine was shown to be effective in two infants as adjunct therapy in the treatment of paradoxical hypertension after coarctectomy. 20 Dexmedetomidine can safely be used in the extubated patient and is helpful in keeping the patient out of pain, less agitated, and calm, thereby preventing the rise in blood pressure and heart rate. 20 …”

Section: Discussionmentioning

confidence: 99%

“… 6 - 19 And new strategies are under development. 20 It is not known which antihypertensive strategy is the most effective, as no randomized controlled trials have been published comparing different strategies in the direct postoperative phase.…”

Section: Introductionmentioning

confidence: 99%

Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children

Roeleveld

Zwijsen

2017

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background:Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin–angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies.Methods:Our aim was to describe the current international practice variation surrounding pharmacological treatment currently being employed to treat paradoxical hypertension following the repair of coarctation of the aorta in children. We performed an online survey among 197 members of the Pediatric Cardiac Intensive Care Society. We also conducted a systematic review of the literature regarding the treatment of paradoxical hypertension.Results:Eighty-eight people (45%), from 62 different centers, responded and answered the questions regarding blood pressure control. Nitroprusside is the first drug of choice for initial blood pressure control in 66% of respondents, esmolol in 11%, labetalol in 11%, and angiotensin-converting enzyme inhibitors (ACEIs) are used by 3% of respondents. For oral blood pressure control after discharge from the pediatric intensive care unit, 75% of respondents use ACEIs, 18% use labetalol, and 12% use other beta-blockers (propranolol, carvedilol, atenolol, metoprolol). The systematic review identified 14 articles reporting pharmacological treatment of direct postoperative hypertension following coarctation repair.Conclusion:There is wide practice variability, due to the lack of sufficient compelling evidence. The majority (66%) of caregivers use nitroprusside to control blood pressure in the acute postoperative phase. The ACEIs are the drug of choice for chronic blood pressure control.

show abstract

“…Management of hypertension after coarctation repair generally requires intensive care unit (ICU) admission and titration of anti-hypertensive infusions [10,11]. Many interventions for blood pressure management in this setting have been assessed including angiotensin-converting enzyme (ACE) inhibitors [12,13,14], beta (β) blockers [15,16,17], calcium channel blockers [18], dexmedetomidine [19], and nitroprusside [16]. While nitroprusside, esmolol and labetalol are most commonly used, there is no consensus on how best to manage these patients postoperatively [11].…”

Section: Introductionmentioning

confidence: 99%

Epidurals for Coarctation Repair in Children Are Associated with Decreased Postoperative Anti-Hypertensive Infusion Requirement as Measured by a Novel Parameter, the Anti-Hypertensive Dosing Index (ADI)

et al. 2019

View full text Add to dashboard Cite

Background: Sympathetically-associated hypertension after coarctation repair is a common problem often requiring anti-hypertensive infusions in an intensive care unit. Epidurals suppress sympathetic output and can reduce blood pressure but have not been studied following coarctation repair in children. We sought to determine whether epidurals for coarctation repair in children were associated with decreased requirement for postoperative anti-hypertensive infusions, if they were associated with changes in hospital course, or with complications. Methods: In this observational retrospective cohort study, we evaluated all patients age 1–18 years undergoing coarctation repair at our institution during a 10-year period and compared the requirement for postoperative anti-hypertensive infusions in patients with and without epidurals using an anti-hypertensive dosing index (ADI) incorporating total dose-hours of all anti-hypertensive infusions (primary outcome). We also assessed intensive care unit (ICU) and hospital length of stay, discharge on oral anti-hypertensive medication, and complications potentially related to epidurals (secondary outcomes). Results: Children undergoing coarctation repair with epidurals had decreased requirements for postoperative anti-hypertensive infusions compared to children without epidurals (cumulative ADI 65.0 [28.5–130.3] v. 157.0 [68.6–214.7], p = 0.021; mean ADI 49.0 [33.3–131.2] v. 163.0 [66.6–209.8], p = 0.01). After multivariable cumulative logit mixed-effects regression analysis, mean ADI was decreased in patients with epidurals throughout the postoperative period (p < 0.001). Patients with epidurals were 1.6 years older and weighed 10.6 kg more than patients without epidurals but were otherwise comparable. Epidural complications included pruritus (three patients), agitation (one patient), somnolence (one patient), and transient orthostatic hypotension (one patient). Duration of intensive care unit admission, duration of hospital stays, and requirement for anti-hypertensive medication at discharge were similar in patients with and without epidurals. Conclusions: This is the first study of children receiving an epidural for surgical repair of aortic coarctation via open thoracotomy. In this small, single-institution, observational retrospective cohort study, epidurals for coarctation repair in children were associated with decreased postoperative anti-hypertensive infusion requirements. Epidurals were not associated with length of ICU or hospital stay, or with discharge on anti-hypertensive medication. No significant epidural complications were noted. Prospective study of larger populations will be necessary to confirm these associations, address causality, verify safety, and assess other effects.

show abstract

Use of dexmedetomidine as an adjunct in the treatment of paradoxical hypertension after surgical repair of coarctation of the aorta in infants

Cited by 4 publications

References 7 publications

Assessment the effect of dexmedetomidine on incidence of paradoxical hypertension after surgical repair of aortic coarctation in pediatric patients

Assessment the effect of dexmedetomidine on incidence of paradoxical hypertension after surgical repair of aortic coarctation in pediatric patients

Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children

Epidurals for Coarctation Repair in Children Are Associated with Decreased Postoperative Anti-Hypertensive Infusion Requirement as Measured by a Novel Parameter, the Anti-Hypertensive Dosing Index (ADI)

Contact Info

Product

Resources

About