Table 2.

Agents used in the management of perioperative hypertension, preferred conditions, and dosing

Agent	Conditions	Dosing
Enalaprilat	Congestive heart failure	IV injection of 1.25 mg over 5 min every 6 h, titrated by increments of 1.25 mg at 12 to 24 h intervals to a maximum of 5 mg every 6 h.
Esmolol	Acute myocardial ischemiaa	Loading dose of 500–1000 μg/kg over 1 min, followed by an infusion at 25 to 50 μg/kg/min, which may be increased by 25 μg/kg/min every 10 to 20 min until the desired response to a maximum of 300 μg/kg/min
Fenoldopam	Acute myocardial ischemiac Acute pulmonary edema/diastolic dysfunctiona,b Acute ischemic stroke/intracerebral bleed Acute renal failure/microangiopathic anemia Hypertensive encephalopathy Sympathetic crisis	An initial dose of 0.1 μg/kg/min, titrated by increments of 0.05 to 0.1 μg/kg/min to a maximum of 1.6 μg/kg/min.
Labetalol	Acute aortic dissection Acute myocardial ischemiaa Acute ischemic stroke/intracerebral bleed Eclampsia/Preeclampsia Hypertensive encephalopathy	Initial bolus 20 mg, followed by boluses of 20–80 mg or an infusion starting at 1–2 mg/min and titrated up to until the desired hypotensive effect is achieved is particularly effective. Bolus injections of 1 to 2 mg/kg have been reported to produce precipitous falls in BP and should therefore be avoided; maximum cumulative dose of 300 mg over 24 h
Nicardipine	Acute myocardial ischemiac Acute renal failure/microangiopathic anemia	5 mg/h; titrate to effect by increasing 2.5 mg/h every 5 min to a maximum of 15 mg/h.
	Acute ischemic stroke/intracerebral bleed Eclampsia/preeclampsia Hypertensive encephalopathy Sympathetic crisis/cocaine overdosed

^aNotes: In combination with nitroglycerin (up to 200 μg/min); In combination with a loop diuretic; May be added if pressure is controlled poorly with labetalol/esmolol alone; In combination with a benzodiazepine.