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In comparison with midazolam, clonidine 4 ug/kg reduced sevoflurane-induced emergence agitation with
- Philippe Van der Linden (1 June 2007)
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Lack of side effects for clonidine vs midazolam for post operative agitation in children.
- Ian J Wrench (29 May 2007)
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Philippe Van der Linden
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We were interested to read the comment of Dr Wrench concerning the incidence of side effects associated with the preoperative use of clonidine to reduce sevoflurane-induced emergence agitation. However, we could not agree with his statement that there was an increased incidence of postoperative hypotension and bradycardia. First, the incidence of postoperative hypotension and bradycardia was not significantly different between the clonidine 4 µg.kg-1 and the midazolam groups. Discussion on the fact that this difference might become significant in a more powerful study is highly speculative, in particular concerning the incidence of bradycardia which was 1/20 patients in the clonidine 4 µg.kg-1 group and 0/20 patients in the midazolam group. Second, only the 4 ug.kg-1 dose of clonidine was effective in reducing sevoflurane-induced emergence agitation. In comparison to the 2 µg.kg-1 dose, the incidence of postoperative hypotension (5/20 in each group)or bradycardia (3/20 in the 2 µg.kg-1 dose versus 1/20 in the 4 µg.kg-1 dose) was certainly not increased. Third, episodes of hypotension and/or bradycardia did not require any treatement in any of the children. After leaving the recovery room, all the children had an uneventful postoperative course. We therefore believe that in comparison with midazolam, clonidine 4 ug.kg- 1 reduced sevoflurane emergence agitation without increasing clinically relevant postoperative side-effects. Conflict of Interest:None declared |
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Ian J Wrench, anaesthetist
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I was interested to read the study concerning the use of midazolam or clonidine premedication for children undergoing sevoflurane anaesthesia. This clearly showed that clonidine effectively reduced the incidence of postoperative agitation in comparison to the benzodiazepine group. A key finding of the study was that this beneficial effect was achieved "without increasing postoperative side effects". On reviewing the paper it can be seen that there is a higher incidence of hypotension in the two clonidine groups (25%) as compared to the midazolam group (10%). It is also the case that postoperative bradycardia only occured in the groups receiving clonidine (4 out of 40 patients). These differences may not have reached statistical significance but it is quite possible that this would have been the case in a more powerful study. I believe that it would have been more appropriate to state that there was an increased incidence of postoperative hypotension and bradycardia for patients receiving clonidine, but that this did not reach statistical significance. Whilst it is compelling to believe that an intervention may be made without negative effects, sadly this is seldom the case. The evidence presented in the paper does not support the author's assertion. Conflict of Interest:None declared |
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