British Journal of Anaesthesia, 2002, Vol. 88, No. 6 790-796
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children
1Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110,D-69120 Heidelberg, Germany 2Present address: Department of Anaesthesiology, University of Tübingen, Germany*Corresponding author
Presented in part at the meeting of the German Society of Anaesthesiology, May 5–8, 1999, Wiesbaden, Germany and the Annual Meeting of the American Society of Anesthesiologists, October 9–13, 1999, Dallas, Texas.
Background. In children, sevoflurane anaesthesia is associated with postanaesthetic agitation, which is treated mainly with opioids. We compared the effectiveness of epidural and i.v. clonidine in the prevention of this postanaesthetic agitation.
Methods. Eighty children aged 3–8 yr (ASA I–II) received standardized general anaesthesia with inhaled sevoflurane and caudal epidural block with 0.175% bupivacaine 1 ml kg–1 for minor surgery. The children were assigned randomly to four groups: (I) clonidine 1 µg kg–1 added to caudal bupivacaine; (II) clonidine 3 µg kg–1 added to caudal bupivacaine; (III) clonidine 3 µg kg–1 i.v. and caudal bupivacaine; and (IV) caudal block with bupivacaine, no clonidine (control). A blinded observer assessed the behaviour of the children during the first postoperative hour. Secondary end-points were the time to fitness for discharge from the postanaesthesia care unit, and haemodynamic and respiratory variables.
Results. The incidence of agitation was 22, 0, 5 and 39% in groups I, II, III and IV respectively (P<0.05 for groups II and III compared with group IV). During the first hour after surgery, patients in groups II and III had significantly lower scores for agitation than group IV patients. Time to fitness for discharge did not differ between the four groups.
Conclusions. Clonidine 3 µg kg–1 prevented agitation after sevoflurane anaesthesia, independently of the route of administration. The effect of clonidine appears to be dose-dependent, as an epidural dose of 1 µg kg–1 failed to reduce it.
Br J Anaesth 2002; 88: 790–6
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