Preliminary experience with clevidipine in the pediatric population

Abstract

Clevidipine is a third-generation calcium channel antagonist of the dihydropyridine group. Like nicardipine, its primary physiologic effect is vasodilation, primarily of the arterial system with limited effects on capacitance vessels. Unlike other direct-acting vasodilators, it has an ultrashort half-life due to its metabolism by nonspecific blood and tissue esterases. To date, the majority of clinical experience with clevidipine has been in the adult cardiac surgery population, with no reports regarding its use in the pediatric population. We retrospectively reviewed our preliminary experience with the use of this novel agent in a cohort of 10 pediatric-aged patients ranging in age from 9 to 18 years. The indications for the use of clevidipine included control of perioperative hypertension in 4 patients, to provide controlled hypotension during orthopedic surgical procedures in 5 patients, and to improve distal perfusion during a toe-to-finger implant in 1 patient. One patient who presented to the operating room with hypertension received clevidipine preoperatively, intraoperatively, and postoperatively; 7 other patients received clevidipine only intraoperatively while the other 2 patients received clevidipine intraoperatively and postoperatively. The clevidipine infusion was started at 0.5 to 1 μg/kg per minute and titrated up to 3.5 μg/kg per minute as needed. No excessive hypotension was noted; however, intermittent doses of metoprolol were required to control reflex tachycardia in 2 of the 10 patients and an elevated triglyceride level was noted in 1 patient. Our preliminary experience demonstrates the efficacy of clevidipine for blood pressure control during the perioperative period.