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LETTER TO THE EDITOR

Supplementation of Intrathecal Bupivacaine with Clonidine in Ex-Premature Neonates

Department of Anesthesiology; American University of Beirut-Medical Center; Beirut, Lebanon; mm01{at}aub.edu.lb

To the Editor:

We read with interest the report of Rochette et al. (1) about neonates <60 wk postconceptual age (PCA) with former prematurity in 50% of the cases, scheduled for inguinal herniotomy who received spinal bupivacaine supplemented with various doses of clonidine. Supplementation with 1 µg/kg intrathecal clonidine doubled the duration to full motor recovery as compared with a control group. This dose of clonidine was not associated with significant hemodynamic or respiratory alterations in the early postoperative period.

We performed spinal anesthesia with 1 mg/kg bupivacaine and 1 µg/kg clonidine in two ex-premature and anemic neonates undergoing bilateral inguinal herniotomy (postconceptual ages, 49 and 39 weeks). The duration of the block until full motor recovery was 120 and 90 min, respectively. Both neonates were sedated during surgery, but respiratory rate was maintained at 30–40 breaths/min during surgery and in the postanesthesia care unit. One episode of intraoperative bradycardia (85 bpm) occurred in one neonate and was treated with 0.1 mg atropine. Postoperatively, 24-h apnea monitoring did not reveal any respiratory depression.

Extending the duration of a single-shot spinal anesthesia with intrathecal clonidine is attractive because it avoids the use of supplemental anesthesia in high-risk neonates. However, despite the safe use of this technique in Rochette’s study and in our patients, monitoring of apnea postoperatively is required because concerns have been raised regarding the potential for respiratory depression after caudal clonidine in neonates (2–4). A 24-h investigation on a large number of patients should be conducted to confirm the absence of long-term effects of spinal clonidine in newborns.

References

1. Rochette A, Raux O, Troncin R et al. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg 2004;98:56–9.[Abstract/Free Full Text]
2. Breschan C, Krumpholz R, Likar R et al. Can a dose of 2 µg · kg_–1 caudal clonidine cause respiratory depression in neonates? Paediatr Anaesth 1999;9:81–3.[Web of Science][Medline]
3. Bouchut JC, Dubois R, Godart J. Clonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea. Reg Anesth Pain Med 2001;26:83–5.[Web of Science][Medline]
4. Fellmann C, Gerber AC, Weiss M. Apnoea in a former preterm infant after caudal bupivacaine with clonidine for inguinal herniorrhaphy. Paediatr Anaesth 2002;12:637–40.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aouad, M. T. Articles by Hajj, R. E. Search for Related Content PubMed PubMed Citation Articles by Aouad, M. T. Articles by Hajj, R. E.