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Efficacy of oral clonidine premedication in children
K Mikawa1, N Maekawa, K Nishina
1Department of Anaesthesiology, Kobe University School of Medicine, Japan.
Insights
Oral clonidine effectively sedates children before surgery, with a 4 micrograms/kg dose improving separation and mask acceptance. This dose also attenuated hemodynamic changes during anesthesia induction.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Clonidine, an alpha 2-adrenoceptor agonist, is a known effective preanesthetic medication in adults.
- Limited data exists on its efficacy in pediatric preanesthesia.
Purpose of the Study:
- To investigate the efficacy of two oral clonidine doses as a premedicant in children.
- To compare clonidine's effects with diazepam in pediatric surgical patients.
Main Methods:
- A prospective, randomized, double-blind, controlled trial involving 105 children (4-12 yr) undergoing elective ophthalmologic surgery.
- Children received oral diazepam, 2 mcg/kg clonidine, or 4 mcg/kg clonidine, followed by oral atropine.
- Observer noted sedation, separation quality, and mask acceptance; hemodynamic changes were compared.
Main Results:
- Clonidine demonstrated dose-related sedation.
- The 4 mcg/kg clonidine dose improved separation quality and mask acceptance.
- This dose attenuated post-intubation increases in blood pressure and heart rate without adverse effects.
Conclusions:
- Oral clonidine, particularly at 4 mcg/kg combined with atropine, is an effective premedication in pediatric surgery.
- Further research is needed to determine the optimal and safest dose of clonidine for this population.
Background:
Clonidine, an alpha 2-adrenoceptor agonist, has been shown to be effective as a preanesthetic medication in adults. The current study was designed to investigate the efficacy of two doses of oral clonidine as a premedicant preceding oral atropine in children.
Methods:
In a prospective, randomized, double-blind, controlled clinical trial, 105 children, aged 4-12 yr, undergoing elective ophthalmologic surgery received 0.4 mg/kg diazepam, 2 micrograms/kg clonidine, or 4 micrograms/kg clonidine orally. These agents mixed with apple juice were administered 105 min before the estimated time of induction of anesthesia, and were followed by treatment with 0.03 mg/kg oral atropine 60 min before anesthesia. A blinded observer noted the children's level of sedation, quality of separation from parents, and degree of acceptance of mask application during inhalation of nitrous oxide used for establishment of venous access. Anesthesia was induced with 5 mg/kg thiamylal, and tracheal intubation was facilitated with 0.2 mg/kg vecuronium. Hemodynamic changes after tracheal intubation were compared among the three groups.
Results:
Clonidine produced significant sedation, and the effect was dose related. Clonidine, 4 micrograms/kg, provided better quality of separation and acceptance of mask than the two other regimens. This dose of clonidine attenuated the increases in blood pressure and heart rate after tracheal intubation. No clinically significant perioperative hypotension or bradycardia was observed.
Conclusions:
These data indicate that, even in pediatric surgery, the combination of 4 micrograms/kg and 0.03 mg/kg oral clonidine is an effective premedication. However, the safety and optimal dose of clonidine in this setting remain to be determined.