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Clonidine in pediatric anesthesia: the new panacea or a drug still looking for an indication?

Arash Afshari1

  • 1Department of Pediatric and Obstetric Anesthesia, Rigshospitalet, Juliane Marie Center, University of Copenhagen, Copenhagen Ø, Denmark.

Current Opinion in Anaesthesiology
|May 3, 2019
PubMed

Insights

Clonidine is a safe and effective medication for pediatric patients, reducing agitation, opioid use, and nausea. Further research is needed for infants and hemodynamically unstable children.

Area of Science:

  • Pediatric Anesthesia
  • Pharmacology
  • Critical Care Medicine

Background:

  • Clonidine, an alpha2-receptor agonist, is a versatile medication in pediatrics.
  • Its applications span from managing postoperative emergence agitation to providing analgesia, anxiolysis, and sedation.
  • In the context of 'opioid-free' medicine, clonidine offers a safe, cost-effective, and globally available alternative.

Purpose of the Study:

  • To review and analyze the current evidence for clonidine's use in pediatric anesthesia.
  • To evaluate its efficacy in various pediatric indications, including a meta-analysis for emergence agitation prevention.

Main Methods:

  • Systematic review of randomized clinical trials.
  • Meta-analysis specifically for the prevention of postoperative emergence agitation.
  • Analysis of evidence for sedation in pediatric intensive care units (ICUs).

Main Results:

  • Clonidine significantly reduces postoperative emergence agitation, opioid consumption, shivering, nausea, and vomiting in healthy children.
  • Emerging evidence supports its use for sedating critically ill children in ICUs.
  • The review includes a meta-analysis demonstrating clonidine's effectiveness in preventing emergence agitation.

Conclusions:

  • Clonidine is a safe and beneficial drug in pediatric anesthesia, supported by moderate to high-quality evidence.
  • High-quality trials are urgently needed for specific populations, including children under 12 months and those with hemodynamic instability.
Abstract

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