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Anesth Analg 2003;96:976-981
© 2003 International Anesthesia Research Society

PEDIATRIC ANESTHESIA

Clonidine Facilitates Controlled Hypotension in Adolescent Children

Thomas Hackmann, MD FRCPC*,{dagger}, Marvin Friesen, MD FRCPC*, Suzanne Allen, BSc RRT*, and David S. Precious, DDS MSc, FRCD{ddagger}

*Department of Paediatric Anaesthesia, IWK Health Centre, Halifax, Nova Scotia, Canada; and Departments of {dagger}Anesthesia and {ddagger}Oral and Maxillofacial Sciences, Dalhousie University, Halifax, Nova Scotia, Canada

Address correspondence and reprint requests to Thomas Hackmann, MD, FRCPC, Department of Paediatric Anaesthesia, IWK Health Centre, Box 3070, Halifax, Nova Scotia, Canada, B3J 3G9. Address e-mail to thomas.hackmann{at}dal.ca

In this randomized, double-blinded, placebo-controlled trial, we investigated whether clonidine lessened the requirements for isoflurane, fentanyl, and labetalol to provide controlled hypotension in children who underwent oromaxillofacial surgery. We also studied preoperative sedative effects, the hemodynamic response to nasotracheal intubation, and recovery characteristics. Thirty-nine healthy children, aged 10–16 yr, received clonidine 5 µg/kg or placebo on the night before surgery and 90 min before surgery. By self-assessment, children in both groups showed similar anxiety, whereas observers rated clonidine patients as more sedated (P < 0.01). Heart rate during induction remained significantly decreased in clonidine patients compared with placebo patients (P < 0.001), as did arterial blood pressure before induction (P < 0.01) and peak pressure after intubation (P < 0.001). Children who took clonidine required significantly less isoflurane to maintain a mean arterial blood pressure of 60 ± 4 mm Hg (mean isoflurane concentration, clonidine 0.99% versus placebo 1.33; P = 0.0004) and required less fentanyl than placebo patients (P = 0.002). Fewer treatment patients received labetalol (clonidine, n = 3 versus placebo, n = 13; P = 0.004). There was a trend toward faster recovery in the clonidine group, with a shortened recovery room stay (P = 0.03). We conclude that clonidine is a useful adjunct for controlled hypotension in children.

IMPLICATIONS: This study shows that adolescents having major jaw surgery are helped by the blood pressure-decreasing drug clonidine. This drug allows smaller doses of anesthetics, pain relievers, and blood pressure-decreasing drugs to be used; reduces changes in heart rate and blood pressure; and provides faster recovery from the anesthetic.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.