• Gareth A Charlton, David R Ladd, Richard M Friesen, and Robert H Friesen.
• Shackleton Department of Anaesthesia, University Hospitals Southampton NHS Trust, Southampton, UK.
• J. Cardiothorac. Vasc. Anesth. 2020 Dec 1; 34 (12): 3348-3351.

ObjectiveParadoxical hypertension after repair of coarctation of the aorta in children is associated with the release of catecholamines and activation of the renin-angiotensin system. The objective of the present study was to describe the effects of labetalol infusion on blood pressure, plasma catecholamine levels, and plasma renin activity in a series of children undergoing repair of coarctation of the aorta.DesignProspective, observational cohort study.SettingTertiary children's hospital with university affiliation.ParticipantsThe study was comprised of 15 consecutive children older than 1 year undergoing repair of coarctation of the aorta.InterventionsIntravenous infusion of labetalol, up to 20 µg/kg/min, was administered when patients became hypertensive after release of the aortic cross-clamp. Supplementation with nitroprusside was allowed as needed.Measurements And Main ResultsBlood pressure was maintained below baseline values throughout the labetalol infusion. Plasma norepinephrine increased from 160 ± 81 pg/mL (preoperative) to 657 ± 268 pg/mL (6 h after release of aortic cross-clamp). Plasma renin activity decreased from 16.6 ± 9.7 ng/kg/h (at cross-clamp release) to 2.2 ± 2.2 ng/kg/h (6 h after cross-clamp release). Nitroprusside was added for 12 patients, at a highest mean dose of 2.4 ± 2.5 μg/kg/min.ConclusionsLabetalol inhibited activation of the renin-angiotensin system and helped control paradoxical hypertension after coarctation repair in children.Copyright © 2020. Published by Elsevier Inc.

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