Safety of Intrathecal Clonidine as an Adjuvant to Spinal Anesthesia in Infants and Children

Preliminary clinical studies have demonstrated that clonidine is an effective adjuvant to spinal anesthesia in neonates and infants. However, the studies conducted previously have had a limited cohort size of 80-100, potentially limiting an accurate measure of its safety.

The current study retrospectively examines our 5-6-year experience with clonidine as an adjuvant to spinal anesthesia in a large cohort of neonates and infants.

The study cohort included 1420 patients ranging in age from newborn to 36 months (median age 7 months). Ninety-five percent of the patients tolerated spinal anesthesia without requiring conversion to general anesthesia, and over 73% of the patients did not require any additional intraoperative sedation. Hypotension (sBP ≤ 60 mmHg) was the most common intraoperative event (17%) with one patient requiring the administration of an anticholinergic agent for bradycardia. No serious intraoperative adverse events were noted. Post Anesthesia Care Unit (PACU) Phase I was bypassed in 75% of cases, and the postoperative admission rate was 7%, with the majority (85%) being planned admissions. Fifty-six patients (4%) returned to the hospital during the first seven postoperative days, primarily for surgical concerns.

Based on this retrospective, observational study, clonidine appears to be a safe adjuvant to spinal anesthesia for ambulatory surgical procedures in infants and children. We observed a low incidence of intraoperative and postoperative complications.