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PEDIATRIC ANESTHESIA

The Reduction in Minimum Alveolar Concentration for Tracheal Extubation After Clonidine Premedication in Children

Yuichi Yaguchi, MD^*, Shinichi Inomata, MD^*, Shin-ichi Kihara, MD^*, Yasuyuki Baba, PhD, Yukinao Kohda, PhD, and Hidenori Toyooka, MD^*

*Department of Anesthesiology, Institute of Clinical Medicine, and Department of Clinical Pharmacy, University of Tsukuba, Tsukuba City, Ibaraki, Japan

Address correspondence and reprint requests to Shinichi Inomata, MD, Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305-8575, Japan. Address e-mail to inomatas{at}md.tsukuba.ac.jp

The effects of clonidine on minimum alveolar concentration for tracheal extubation (MAC-ex) have not been elucidated. Clonidine may lead to prolonged emergence from anesthesia. We investigated the effects of oral clonidine premedication on MAC-ex and examined the emergence properties of sevoflurane in children. Sixty ASA physical status I pediatric patients, aged from 2 to 9 yr, were randomly divided into one of three groups and received placebo, clonidine 2 µg/kg, or clonidine 4 µg/kg (n = 20 each) orally, 100 min before the induction of anesthesia. The induction of anesthesia, tracheal intubation, and maintenance of anesthesia were performed with sevoflurane in air and oxygen. MAC-ex was defined according to the modification of Dixon’s up-and-down method, with 0.25% as a step size. In addition, in the Control and 4 µg/kg groups, the time from tracheal extubation to spontaneous eye opening (eye-opening time) and the time from tracheal extubation to leaving the operating room (awakening time) were recorded. MAC-ex for sevoflurane (mean ± SD) was 1.63% ± 0.13%, 1.04% ± 0.26%, and 0.66% ± 0.09% respectively in the Control group, 2 µg/kg group, and 4 µg/kg group. Significant differences were observed among the three groups. The eye-opening times were 5.7 ± 3.5 min in the Control group and 5.1 ± 1.0 min in the 4 µg/kg group. The awakening times were 9.7 ± 3.7 min in the Control group and 9.2 ± 3.8 min in the 4 µg/kg group. No significant differences were observed among the groups.

IMPLICATIONS: Oral clonidine premedication decreased MAC for tracheal extubation for sevoflurane dose dependency and did not prolong emergence from anesthesia.

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