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BJA Advance Access originally published online on April 7, 2007
British Journal of Anaesthesia 2007 98(5):667-671; doi:10.1093/bja/aem071
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial{dagger}

N. Tazeroualti1, F. De Groote1, S. De Hert2, A. De Villé1, A. Dierick1 and P. Van der Linden1,*

1 Department of Anaesthesia, CHU-Brugmann – HUDERF, 4, Place Van Gehuchten, B-1020 Brussels, Belgium
2 Department of Anaesthesia, University Hospital Antwerp, 10, Wilrijkstraat, B-2650 Edegem, Belgium

* Corresponding author. E-mail: philippe.vanderlinden{at}chu-brugmann.be

Background: This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane.

Methods: Sixty-eight ASA I–II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg–1, clonidine 2 µg kg–1, and clonidine 4 µg kg–1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg–1) and rectal paracetamol (30 mg kg–1). During the first postoperative hour, children were evaluated using a modified ‘objective pain scale’.

Results: Only the 4 µg kg–1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 µg kg–1 group displayed agitation (25%) than in the midazolam group (60%) (P = 0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups.

Conclusions: In comparison with midazolam, clonidine 4 µg kg–1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.

Keywords: anaesthetics volatile, sevoflurane; anaesthesia, paediatric; premedication, clonidine; recovery, postoperative

{dagger} Presented in part at the 2006 European Society of Anaesthesiologists meeting, Madrid, Spain.


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E-letters:

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Lack of side effects for clonidine vs midazolam for post operative agitation in children.
Ian J Wrench
British Journal of Anaesthesia, 29 May 2007 [Full text]
In comparison with midazolam, clonidine 4 ug/kg reduced sevoflurane-induced emergence agitation with
Philippe Van der Linden
British Journal of Anaesthesia, 1 Jun 2007 [Full text]

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