Nicardipine to control mean arterial pressure after cardiothoracic surgery in infants and children.

Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiologic action includes vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Several previous reports document its use in adult patients for pharmacologic control of blood pressure. The current report describes the use of nicardipine to control mean arterial pressure (MAP) in nine infants and children after cardiothoracic surgical procedures. The patients ranged in age from 6 days to 9 years (mean, 3.3 +/- 4.1 years) and in weight from 4.1 to 49 kg (mean, 15.3 +/- 14.4). The surgical procedures included aortic coarctation repair (three), repair of tetralogy of Fallot (two), arterial switch for transposition of the great vessels (two), pulmonary valvotomy (one), and aortic valvotomy (one). The target systolic blood pressure was 90 mm Hg in patients younger than 4 years of age and < or = 110 mm Hg in patients 5 years of age or older. The nicardipine infusion was started at 5 microg/kg/min in all patients. The target blood pressure was achieved within 15 minutes in eight of nine patients. One patient required an initial infusion rate of 10 microg/kg/min to achieve the target blood pressure. The maintenance infusion rate varied from 2.5 to 5.5 mcg/k/min (mean 3.0 +/- 1.1). The duration of the infusion varied from 30 to 42 hours (mean, 37.4 +/- 4.2). In the nine patients, nicardipine was infused for a total of 337 hours. No adverse effects such as excessive hypotension were noted. Nicardipine is an effective agent for controlling MAP after cardiothoracic surgical procedures in infants and children.