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Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study.

Author(s): Ghosh SM, Agarwala RB, Pandey M, Vajifdar H

Affiliation(s): Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India. dr.raktimghosh@gmail.com

Publication date & source: 2011-05, Eur J Anaesthesiol., 28(5):329-33.

Publication type: Comparative Study; Randomized Controlled Trial

BACKGROUND: Sevoflurane is commonly used as an inhalational induction agent in paediatric patients. Emergence agitation is a common post-operative problem in young children who have received sevoflurane. Clonidine has proven to be effective in reducing the incidence of post-operative agitation at a higher dose (3 and 2 mug kg(1)). It has some dose-dependent disadvantages, prominently bradycardia, hypotension and respiratory impairment. OBJECTIVE: The authors conducted a study to evaluate the effectiveness of low-dose caudal clonidine (1 mug kg(1)) in reducing the incidence of sevoflurane-induced agitation in preschool children undergoing urogenital and lower limb surgery. METHODOLOGY: A double-blind study was conducted comparing 0.25% (0.75 ml kg(1)) bupivacaine and clonidine 1 mug kg(1) (group 1), 0.25% bupivacaine (0.75 ml kg(1)) and clonidine 0.75 mug kg(1) (group 2), with 0.25% bupivacaine (0.75 ml kg(1)) alone (group 3). Ninety children of 1-5 years of American Society of Anesthesiologists I and II were randomly assigned into three groups. Post-operatively, patients were monitored for 1 h to observe emergence agitation, which was assessed with the help of Pain and Discomfort Scale. RESULT: Post-anaesthetic agitation was observed in two patients (6.6%) in group 1, eight patients (26.6%) in group 2 as compared to 12 patients (40%) in group 3 after 15 min of post-operative observation. The mean scores in group 1 at 15 and 30 min were significantly lower than those in group 3 (P value <0.05). None of the groups had showed any haemodynamic and respiratory compromise, either clinically and statistically. CONCLUSION: Caudal clonidine at a lower dose (1 mug kg(1)) could be effective in reducing the incidence of sevoflurane-induced emergence agitation in children undergoing urogenital and lower limb surgery without any significant adverse effects.

Page last updated: 2011-12-09

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