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LETTER TO THE EDITOR

Supplementation of Intrathecal Bupivacaine with Clonidine in Ex-Premature Neonates

Department of Anesthesiology and Critical Care Medicine; University Hospital Lapeyronie; Montpellier, France; a-rochette{at}chu-montpellier.fr

In Response:

We thank Drs. Aouad and Hajj for their interest in our work (1), as well as for their comments. A further confirmation of the efficacy of our approach is welcome. Since this work was initiated, we have performed about 500 clonidine-supplemented spinal anesthesia in neonates and this series highlights our positive opinion. However, we fully agree with Aouad and Hajj’s recommendation to monitor closely these patients for 24 h, because i) spinal anesthesia reduces but does not eliminate the risk of postoperative apnea (2) and ii) clonidine may affect postoperative respiratory course, as advocated by the three case reports our colleagues mentioned. We have specifically addressed this question in a 24-h descriptive study to be published on more than 120 infants (3). As the results appear encouraging, we have designed a prospective comparative study to clarify benefits and limits of this approach.

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. Shenkman Z, Hoppenstein D, Litmanowitz I, et al. Spinal anesthesia in 62 premature, former-premature or young infants: technical aspects and pitfalls. Can J Anesth 2002;49:262–9.[Web of Science][Medline]
3. Rochette A, Troncin R, Raux O, et al. Clonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants. Ped Anesth 2005;

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