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PEDIATRIC ANESTHESIA

Clonidine Prevents Sevoflurane-Induced Agitation in Children

Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Klinikum Kassel, Oberhausen, Germany

Address correspondence and reprint requests to Priv.-Doz. Dr. P. J. Kulka, Department of Anesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Oberhausen, EKO, Virchowstrasse 20, D-46047 Oberhausen, Germany. Address e-mail to Peter.Kulka{at}ruhr-uni-bochum.de

In a double-blinded trial, 40 male children (age 2–7 yr) undergoing circumcision were randomly assigned to receive clonidine 2 µg/kg IV or placebo after anesthetic induction. For induction and maintenance of anesthesia, we used sevoflurane as the sole anesthetic. For pain treatment, a penile block was performed before surgery. After surgery the incidence and severity of agitation was mea-sured during an observation period of 2 h. Severe agitation was treated with midazolam. In 16 placebo and 2 clonidine-treated patients agitation was observed (P < 0.001). In 6 patients of the Placebo group, agitation was graded as severe, whereas none of the patients in the Clonidine group developed severe agitation (P = 0.02). During the postoperative period heart rate and blood pressure were significantly decreased in clonidine treated patients (P < 0.05). We conclude that clonidine effectively prevents agitation after sevoflurane anesthesia.

IMPLICATIONS: The recovery from sevoflurane anesthesia may be complicated by the presence of agitation in pediatric patients. Clonidine 2 µg/kg IV after anesthetic induction effectively reduces the incidence of agitation without resulting in clinically relevant bradycardia and hypotension.

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