Clonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants.
BACKGROUND
Spinal anesthesia (SA) remains the 'gold standard' in neonatal anesthesia for inguinal herniorrhaphy but its short duration impedes its usefulness. We previously demonstrated that clonidine prolongs neonatal SA without immediate side effects.


METHODS
We conducted a prospective observational study of 124 infants undergoing herniorrhaphy under SA with bupivacaine and clonidine. Two cohorts, term (n = 57) and former preterm (n = 67) infants, were evaluated and compared with regard to episodes of apnea, desaturation, and bradycardia within 24 h of SA.


RESULTS
In both groups, postoperative desaturation episodes were unchanged after SA, compared with the 12 preoperative hours, despite significantly increased apnea (P < 0.003 and <0.011 respectively). Transient bradycardias occurred in former preterm infants (P < 0.014): they spontaneously resolved in all cases. Mean arterial pressure did not vary during the study. Upper sensory level of SA, sedation on entering the postanesthesia care unit (PACU) and duration of stay in the PACU were similar in both groups.


CONCLUSIONS
The clinical significance of short apneas, recovering spontaneously without desaturation, remains debatable. It is concluded that addition of clonidine to neonatal SA results in acceptable side effects. Side effects must be compared with the potential advantages before future recommendations.
Rochette
Alain
A
Department of Anesthesiology and Intensive Care Medicine A, University Hospital Lapeyronie, Montpellier, France. a-rochette@chu-montpellier.fr
Troncin
Rachel
R
Raux
Olivier
O
Dadure
Christophe
C
Lubrano
Jean-François
JF
Barbotte
Eric
E
Capdevila
Xavier
X
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D003000:Clonidine / Q000008:administration & dosage*; D006339:Heart Rate; D006552:Hernia, Inguinal / Q000151:congenital / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D012119:Respiration
D000759:Adjuvants, Anesthesia; D000700:Analgesics; D000779:Anesthetics, Local; D003000:Clonidine; D002045:Bupivacaine