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Intrathecal clonidine decreases propofol sedation requirements during spinal anesthesia in infants

Yatindra K Batra1, Sondekoppam V Rakesh, Nidhi B Panda

  • 1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. ykbatra@glide.net.in

Paediatric Anaesthesia
|July 21, 2010
PubMed

Insights

Intrathecal clonidine or clonidine-fentanyl combinations significantly reduce propofol sedation requirements in infants undergoing surgery. Fentanyl alone did not significantly alter propofol needs, highlighting clonidine

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Surgical Sedation

Background:

  • Propofol is a common agent for procedural sedation in pediatric patients undergoing lumbar puncture and spinal anesthesia.
  • Intrathecal clonidine and fentanyl are used as adjuvants to prolong spinal anesthesia and provide postoperative analgesia.
  • This study investigated the impact of intrathecal clonidine and fentanyl on propofol requirements in infants undergoing lower abdominal surgery.

Purpose of the Study:

  • To evaluate the effect of intrathecal clonidine and fentanyl on the intraoperative propofol sedation requirement in infants undergoing spinal anesthesia.
  • To compare the propofol infusion rates needed when bupivacaine is combined with clonidine, fentanyl, or both, versus bupivacaine alone.

Main Methods:

  • A prospective, randomized, double-blind study involving 65 ASA I infants undergoing elective lower abdominal surgery.
  • Infants were assigned to four groups receiving bupivacaine alone, or bupivacaine with clonidine, fentanyl, or both.
  • Propofol was administered for sedation, with requirements assessed via infusion rates and sedation/reactivity scores.

Main Results:

  • The mean propofol infusion requirement was significantly reduced in infants who received intrathecal clonidine (16.7 microg kg(-1) min(-1)) or clonidine-fentanyl combination (14.8 microg kg(-1) min(-1)) compared to bupivacaine alone (35.5 microg kg(-1) min(-1)).
  • Intrathecal fentanyl alone (33.4 microg kg(-1) min(-1)) did not significantly alter propofol requirements compared to bupivacaine alone.
  • Higher sedation and reactivity scores were observed in the clonidine-containing groups.

Conclusions:

  • Intrathecal adjuvants, particularly clonidine, significantly decrease the need for propofol sedation during pediatric spinal anesthesia.
  • The combination of clonidine and fentanyl offers a similar reduction in propofol requirements as clonidine alone.
  • Fentanyl alone as an intrathecal adjuvant does not significantly impact propofol sedation needs in this population.
Abstract

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