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Transcutaneous CO2 tension effects of clonidine in paediatric caudal analgesia
A Dupeyrat1, E Goujard, J Muret
1Department of Anesthesiology and Intensive Care Medecine, Hôpital de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France.
Insights
Clonidine added to bupivacaine for pediatric caudal analgesia did not cause respiratory depression. This study found no significant increase in transcutaneous CO2 tension (tcPCO2) in children receiving clonidine.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Pain Management
Background:
- Clonidine is used with bupivacaine for analgesia in adults, with minimal respiratory effects.
- Previous studies have not quantified the respiratory effects of clonidine in pediatric patients.
Purpose of the Study:
- To investigate the safety and efficacy of adding clonidine to bupivacaine for caudal analgesia in children.
- To assess the impact of clonidine on respiratory function and sedation levels in pediatric patients.
Main Methods:
- A double-blind study randomized 24 children (9 months to 7 years) into two groups.
- One group received bupivacaine with clonidine (1 microgram.kg-1), the other received bupivacaine with normal saline (placebo).
- Patients were monitored for 3 hours post-procedure for respiratory rate, transcutaneous CO2 tension (tcPCO2), and sedation scores.
Main Results:
- No significant differences in mean tcPCO2 or respiratory rate were observed between the clonidine and placebo groups.
- No apnea or oxygen desaturation below 97% occurred in either group.
- Patients in the clonidine group exhibited prolonged sedation, but without adverse respiratory effects.
Conclusions:
- Clonidine (1 microgram.kg-1) combined with bupivacaine for caudal analgesia in children is safe regarding respiratory function.
- The addition of clonidine provides prolonged sedation without increasing tcPCO2 in pediatric patients.
Abstract:
In adults, clonidine when added to bupivacaine, results in no detectable respiratory depressant effect except when carbon dioxide challenge is performed. However, to date no investigations have quantified this in children. Twenty-four children (nine months to seven years) were randomized in a double-blind study into two groups. After induction, a caudal block was performed with 1 ml.kg-1 0.25% bupivacaine. Clonidine 1 microgram.kg-1 was added in the clonidine group, and 1 ml normal saline in the placebo group. Patients were monitored in the recovery room for three h from arrival to discharge with continuous pulse oximetry, respiratory rate, a transcutaneous CO2 tension (tcPCO2) every 15 min, and a four point sedation score every 30 min. Mean tcPCO2 and respiratory rate values were not different between the two groups. Apnoea and desaturation less than 97% were not observed. The sedation score decreased with time in both groups, and the score time interval was significantly higher in the clonidine group (P < 0.05). All the patients left the recovery room with a sedation score of 1, excepting four in the clonidine group with a sedation score of 2. Clonidine 1 microgram.kg-1 with 0.25% bupivacaine mixture in caudal analgesia in children did not induce an increase in tcPCO2 despite prolonged sedation.