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Oral clonidine premedication reduces vomiting in children after strabismus surgery
K Mikawa1, K Nishina, N Maekawa
1Department of Anaesthesiology, Kobe University School of Medicine, Japan.
Insights
Preoperative oral clonidine at 4 micrograms/kg significantly reduced postoperative vomiting in children undergoing strabismus surgery. Lower doses were ineffective, suggesting this dose may be a superior antiemetic compared to diazepam.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative vomiting is a common complication in pediatric strabismus surgery.
- Sedative premedicants like diazepam are often used, but their antiemetic effects vary.
- Clonidine, an alpha-2 adrenergic agonist, has shown potential antiemetic properties.
Purpose of the Study:
- To evaluate the efficacy of preoperative oral clonidine in preventing postoperative vomiting in children undergoing strabismus surgery.
- To compare the antiemetic effects of different doses of clonidine with placebo and diazepam.
Main Methods:
- Prospective, randomized, double-blind trial involving 140 children (3-12 years) undergoing strabismus surgery.
- Four groups received placebo, diazepam (0.4 mg/kg), clonidine (2 µg/kg), or clonidine (4 µg/kg) orally 100 minutes before anesthesia induction.
- All patients received halothane/nitrous oxide anesthesia, vecuronium for muscle relaxation, and diclofenac for pain; no opioids or antiemetics were administered.
Main Results:
- The 4 µg/kg clonidine group had a significantly lower incidence (11%) and frequency (1.37) of vomiting compared to placebo (34%, 2) and diazepam (3%, 3) (P < 0.05).
- The 2 µg/kg clonidine dose was ineffective in reducing vomiting.
- No significant difference in vomiting was observed between placebo and diazepam groups.
Conclusions:
- Preanesthetic oral administration of clonidine 4 µg/kg is effective in reducing postoperative vomiting after strabismus surgery in children.
- Clonidine at this dose may be a superior alternative to diazepam as a premedicant for its antiemetic properties.
Abstract:
This is a prospective randomized double-blind trial conducted to determine whether preoperative orally administered clonidine causes or potentiates postoperative vomiting in 140 children (3-12 yr) undergoing strabismus surgery. They were all inpatients and classified randomly into four groups (n = 35 each); placebo (control), diazepam 0.4 mg.kg-1, clonidine 2 micrograms.kg-1, and clonidine 4 micrograms.kg-1. These agents were administered 93-112 min (mean; 100 min) before the anticipated time of induction of anaesthesia. All children received inhalational anaesthesia with halothane and nitrous oxide in oxygen. Muscle relaxation in all patients was obtained with vecuronium and residual neuromuscular blockade was antagonized with neostigmine and atropine before tracheal extubation. Diclofenac suppository was prescribed to prevent postoperative pain. No opioids or postoperative antiemetics were administered. All children remained in hospital for two days postoperatively. The incidence and frequency of vomiting were compared in the groups with Kruskall-Wallis Rank test. Clonidine 4 micrograms.kg-1 caused a lower incidence and frequency of vomiting than did placebo and diazepam (incidence and frequency: 11% and 1.37% and 3, and 34% and 2 in clonidine 4 micrograms.kg-1, placebo, and diazepam, respectively; P < 0.05 for clonidine 4 micrograms.kg-1 vs placebo and diazepam). However, low-dose clonidine was ineffective. These data suggest that preanaesthetic medication with clonidine 4 micrograms.kg-1 may be useful for preventing emesis following strabismus surgery. This property of clonidine indicates that it may be superior to other sedative premedicants such as diazepam and midazolam.