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Perioperative Effects and Safety of Nesiritide Following Cardiac Surgery in Children

Heart Care International, Santo Domingo, Dominican Republic; Sibley Heart Center Cardiology, The McGill Building, 2835 Brandywine Road, Suite 300, Atlanta, GA 30341; simsicj{at}kidsheart.com

Mark Scheurer, MD

Heart Care International, Santo Domingo, Dominican Republic; Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC

Joseph D. Tobias, MD

Heart Care International, Santo Domingo, Dominican Republic; Division of Pediatric Anesthesiology/Pediatric Critical Care, University of Missouri, Columbia, MO

John Berkenbosch, MD

Heart Care International, Santo Domingo, Dominican Republic; Division of Pediatrics/Pediatric Critical Care, University of Louisville, Louisville, KY

William Schechter, MD

Heart Care International, Santo Domingo, Dominican Republic; Department of Anesthesiology, Columbia University, New York, NY

Freddie Madera, MD

Heart Care International, Santo Domingo, Dominican Republic

Samuel Weinstein, MD

Robert E. Michler, MD

Heart Care International, Santo Domingo, Dominican Republic; Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, NY

Nesiritide (Natrecor, Scios Inc), human B-type natriuretic peptide, has hemodynamic effects that may be beneficial in pediatric patients after cardiac surgery. Experience with nesiritide and pediatrics is limited. The purpose of this study was to evaluate perioperative effects and safety of nesiritide in pediatric cardiothoracic surgery. Seventeen patients with congenital heart disease undergoing cardiac surgery were given a loading dose (1 µg/kg) while on cardiopulmonary bypass (constant flow) followed by continuous infusion for 24 hours (0.01 µg/kg/min x 6 hours, then 0.02 µg/kg/min x 18 hours). A 7% decrease in mean blood pressure was seen following nesiritide loading dose on cardiopulmonary bypass. No patient required intervention for hypotension while receiving nesiritide load or infusion. Nesiritide load during surgery and continuous infusion after cardiac surgery in pediatric patients resulted in no significant hemodynamic compromise.

Key Words: B-type natriuretic peptide • cardiac surgery • congenital heart disease • pediatrics

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				A. Ryan, D. A. Rosen, and J. D. Tobias Preliminary Experience With Nesiritide in Pediatric Patients Less Than 12 Months of Age J Intensive Care Med, September 1, 2008; 23(5): 321 - 328. [Abstract] [PDF]