Efficacy of oral clonidine premedication in children.
BACKGROUND
Clonidine, an alpha 2-adrenoceptor agonist, has been shown to be effective as a preanesthetic medication in adults. The current study was designed to investigate the efficacy of two doses of oral clonidine as a premedicant preceding oral atropine in children.


METHODS
In a prospective, randomized, double-blind, controlled clinical trial, 105 children, aged 4-12 yr, undergoing elective ophthalmologic surgery received 0.4 mg/kg diazepam, 2 micrograms/kg clonidine, or 4 micrograms/kg clonidine orally. These agents mixed with apple juice were administered 105 min before the estimated time of induction of anesthesia, and were followed by treatment with 0.03 mg/kg oral atropine 60 min before anesthesia. A blinded observer noted the children's level of sedation, quality of separation from parents, and degree of acceptance of mask application during inhalation of nitrous oxide used for establishment of venous access. Anesthesia was induced with 5 mg/kg thiamylal, and tracheal intubation was facilitated with 0.2 mg/kg vecuronium. Hemodynamic changes after tracheal intubation were compared among the three groups.


RESULTS
Clonidine produced significant sedation, and the effect was dose related. Clonidine, 4 micrograms/kg, provided better quality of separation and acceptance of mask than the two other regimens. This dose of clonidine attenuated the increases in blood pressure and heart rate after tracheal intubation. No clinically significant perioperative hypotension or bradycardia was observed.


CONCLUSIONS
These data indicate that, even in pediatric surgery, the combination of 4 micrograms/kg and 0.03 mg/kg oral clonidine is an effective premedication. However, the safety and optimal dose of clonidine in this setting remain to be determined.
Mikawa
K
K
Department of Anaesthesiology, Kobe University School of Medicine, Japan.
Maekawa
N
N
Nishina
K
K
Takao
Y
Y
Yaku
H
H
Obara
H
H
D000284:Administration, Oral; D000769:Anesthesia, Inhalation; D001010:Anxiety, Separation / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D006221:Halothane; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D009609:Nitrous Oxide; D011229:Preanesthetic Medication; D011446:Prospective Studies; D013285:Strabismus / Q000601:surgery
D006993:Hypnotics and Sedatives; D009609:Nitrous Oxide; D003000:Clonidine; D006221:Halothane