Clevidipine resistance in a patient taking aripiprazole and methylphenidate

Abstract

M Alysse Jacklen,1 Jason A Campagna,2 Joseph D Tobias3,4 1The Ohio State University College of Medicine, Columbus, OH, USA; 2Neuro and Critical Care, The Medicines Company, Parsippany, NJ, USA; 3Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA; 4Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA Abstract: Various factors may be responsible for blood pressure alterations during perioperative care. When these physiologic alterations require treatment, several therapeutic options are available. Clevidipine is an ultrashort-acting, intravenous L-type calcium channel antagonist of the dihydropyridine class. Anecdotal experience has demonstrated its efficacy in various clinical scenarios in the pediatric population. We report apparent resistance to the vasodilatory effects of clevidipine in a 13-year-old girl who presented for anesthetic care during posterior spinal fusion for neuromuscular scoliosis whose chronic medication regimen included aripiprazole and methylphenidate for the treatment of depression and attention-deficit/hyperactivity disorder. We discuss the potential interaction of aripiprazole and methylphenidate with the calcium channel antagonists and cellular mechanisms responsible for the resistance to the vasodilatory effects of clevidipine. Keywords: clevidipine, blood pressure, calcium channel antagonist, controlled hypotension, aripiprazole, posterior spinal fusion, labetalol