Pediatrics

Acute Hypertension

Diagnosis

Sustained high blood pressure refractory to treating reversible causes

Hypertensive Blood Pressure Range

  • Age (yr) · Systolic · Diastolic
  • newborn · > 97 · > 70
  • 1-3 · > 105 · > 61
  • 4-12 · > 113 · > 86

Diagnosis

Sustained high blood pressure refractory to treating reversible causes

Hypertensive Blood Pressure Range

  • Age (yr) · Systolic · Diastolic
  • newborn · > 97 · > 70
  • 1-3 · > 105 · > 61
  • 4-12 · > 113 · > 86

  1. In pediatrics, hypertension is almost always treated by addressing likely causes such as light anesthesia or measurement error

    • Ensure correct BP cuff size: cuff bladder width ~40% of limb circumference
    • Ensure arterial line transducer is at level of heart; Consider placing arterial line if not already present

  2. CAUTION: Anti-hypertensive drugs are almost never needed for routine pediatric cases and are used almost exclusively for specialized cardiac, neurosurgical, or endocrine (pheochromocytoma) cases. Consult an expert before use. Rule-out increased ICP.

  3. For direct smooth muscle relaxation, consider

    • Sodium nitroprusside 0.5-10 MICROgrams/kg/min infusion
    • Hydralazine 0.1-0.2 mg/kg (adult dose 5-10 mg)
    • 0.5-10 MICROgrams/kg/min
    • 0.1-0.2 mg/kg (adult dose 5-10 mg)

  4. For β-Adrenergic blockade, consider

    • Esmolol 100-500 MICROgrams/kg over 5 min, then 25-300 MICROgrams/kg/min infusion
    • Labetalol (also α effect) 0.2-1 mg/kg q 10 min; 0.4-3 mg/kg/hour infusion
    • 100-500 MICROgrams/kg over 5 min
    • Then infusion 25-300 MICROgrams/kg/min
    • 0.2-1 mg/kg q 10 min
    • Then infusion 0.4-3 mg/kg/hour

  5. For calcium channel blockade, consider

    • Nicardapine 0.5-5 MICROgrams/kg/min
    • Clevidipine 0.5-3.5 MICROgrams/kg/min
    • 0.5-5 MICROgrams/kg/min
    • 0.5-3.5 MICROgrams/kg/min

  6. For D1-dopamine agonist, consider

    • Fenoldopam 0.2-0.8 MICROgrams/kg/min
    • 0.2-0.8 MICROgrams/kg/min

  7. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  8. Call for Transesophageal Echocardiography

  9. Start chest compressions

  10. Give epinephrine 10 MICROgrams/kg IV/IO

  11. If cardiac arrest, go to CARDIAC ARREST

  12. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.