Drug | Functional class (predominant receptor or mechanism) | Bolus dose | Infusion dose | Comments |
Beta blocking agents – Generally avoided in patients with acute decompensated heart failure | ||||
Esmolol | Beta1-selective adrenergic receptor blockade | 10 to 50 mg, which may be repeated (every 5 to 15 minutes depending upon the initial dose used, the desired effect, and the patient's risk for hemodynamic decompensation) | 50 to 300 mcg/kg/minute |
|
Metoprolol | Beta1-selective adrenergic receptor blockade | 1 to 5 mg, followed by 2.5 to 15 mg every 3 to 6 hours | N/A |
|
Labetalol | Blockade of postsynaptic alpha1-adrenergic receptors and non-selective beta blockade for beta1- and beta2-adrenergic receptors | Initial bolus of 5 to 25 mg, which may be followed by repeated boluses every 10 minutes (up to 300 mg) | 0.5 to 2 mg/minute up to a maximum of 10 mg/minute (generally reserved for hypertensive emergencies) |
|
Calcium channel blocking agents – Use cautiously in patients with increased ICP | ||||
Nicardipine* | Selective dihydropyridine-type calcium channel blocker; selective arteriolar smooth muscle relaxation | 100 to 500 mcg | 5 to 15 mg/hour |
|
Clevidipine | Selective dihydropyridine-type calcium channel blocker; selective arteriolar smooth muscle relaxation | N/A | Initial dose 1 to 2 mg/hour, with rapid titration up to 16 mg/hour |
|
Direct vasodilators (direct relaxation of vascular smooth muscle) – Generally avoided in patients with increased ICP | ||||
Hydralazine | Highly selective vasodilation of arterial resistance vessels | Initial bolus of 2.5 mg followed by repeated boluses every 5 minutes to a maximum 20 mg | N/A |
|
Nitroglycerin (glyceryl trinitrate) | Nitrodilator that causes increased release of NO, resulting in smooth muscle relaxation | 10 to 40 mcg, which may be repeated and/or followed by infusion | 10 to 200 mcg/minute or 0.1 to 3 mcg/kg/minute |
|
Nitroprusside | Nitrodilator that directly releases NO, resulting in smooth muscle relaxation | N/A | 10 to 200 mcg/minute or 0.1 to 3 mcg/kg/minute |
|
Other antihypertensive agents | ||||
Fenoldopam | Selective agonist for D1 dopamine receptors; binds with moderate affinity to alpha2-adrenoceptors | N/A | Initial dose at 0.1 mcg/kg/minute titrated up to a maximum of 1.6 mcg/kg/minute |
|
N/A: not applicable; ICP: intracranial pressure; NO: nitric oxide; SL: sublingual.
* Dose ranges are based on adult patients of average size.
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