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Intravenous clonidine infusion in critically ill children: dose-dependent sedative effects and cardiovascular
1Paediatric Intensive Care Unit, Bristol Royal Hospital for Sick Children, UK.
Insights
Clonidine effectively sedates critically ill children when combined with midazolam. Higher doses (2 mcg/kg/hr) improved sedation success without adverse cardiovascular effects in ventilated pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Critical Care Medicine
- Clinical Pharmacology
Background:
- Clonidine is utilized for analgesia and sedation in pediatric anesthesia.
- Limited data exists on clonidine's sedative efficacy and safety in critically ill children.
Purpose of the Study:
- Determine an effective intravenous dosing range for clonidine in ventilated children.
- Assess the cardiovascular effects of clonidine in this population.
Main Methods:
- Studied 30 ventilated children (10 years and under).
- Administered background midazolam (50 mcg/kg/hr) with variable clonidine infusion (0.1-2 mcg/kg/hr).
- Measured cardiovascular effects, including cardiac index, in 10 postoperative cardiac patients.
Main Results:
- Dose-dependent sedation was achieved, with 713 out of 861 hours meeting sedation goals.
- An infusion limit of 1 mcg/kg/hr clonidine was insufficient in two patients.
- Increasing the clonidine dose limit to 2 mcg/kg/hr with midazolam achieved satisfactory sedation for 602 out of 672 hours without failures.
- Clonidine at 1 mcg/kg/hr did not significantly alter heart rate, arterial pressure, or cardiac index.
Conclusions:
- Intravenous clonidine, in combination with midazolam, provides effective sedation for critically ill children.
- A higher clonidine infusion limit of 2 mcg/kg/hr is safe and effective, with no significant cardiovascular side effects observed.
Abstract:
Clonidine is used for analgesia and sedation in paediatric anaesthesia, but there are no data on its sedative properties and side effects in critically ill children. We studied 30 ventilated children aged 10 yr and under to determine an effective i.v. dosing range and to assess its cardiovascular effects. Twenty non-paralysed, ventilated children were given a background infusion of midazolam 50 micrograms kg-1 h-1 combined with a variable clonidine infusion (0.1-2 micrograms kg-1 h-1) to maintain optimal sedation. The effects of clonidine 1 microgram kg-1 h-1 on cardiac index were measured in 10 postoperative cardiac patients using a reverse Fick method. Dose-dependent sedation was achievable (713 out of 861 h) without cardiovascular side effects, but an infusion limit of clonidine 1 microgram kg-1 h-1 was inadequate in two patients. An increased dose limit of 2 micrograms kg-1 h-1 combined with midazolam 50 micrograms kg-1 h-1 achieved satisfactory sedation scores for 602 out of a total of 672 h studied with no failures. Clonidine in combination with midazolam at 1 microgram kg-1 h-1 was not associated with significant changes in heart rate arterial pressure or cardiac index.