Steal-induction after clonidine premedication: a comparison of the oral and nasal route.
BACKGROUND
Clonidine premedication in children reliably provides preoperative sedation and anxiolysis, but onset of oral clonidine is known to be slow. Nasal clonidine has been shown to reach peak plasma levels within 10 min in rodents. The aim of the present study was to compare clinical effects and percentage of steal-induction after clonidine premedication by the oral and nasal route.


METHODS
Forty children, aged 1-6 years, scheduled for minor infraumbilical surgery, were randomly assigned to receive either pure clonidine 4 microgxkg(-1) intranasally (group CN, n = 20) or clonidine 4 microgxkg(-1) orally in syrup (group CO, n = 20) prior to mask induction. Drug acceptance, preoperative sedation and anxiolysis, quality of mask acceptance, recovery profile and parents' satisfaction were evaluated.


RESULTS
Drug acceptance was similar between groups, but quality of taste was significantly better in the oral group. There was no significant difference of preoperative anxiolysis and sedation. The onset of sedative effect was after 38.3 min for oral clonidine and 47.5 min for nasal clonidine. A steal-induction could be performed in 60% of children in each group. Emergence from anesthesia and parents' satisfaction were comparable.


CONCLUSIONS
Intranasal clonidine administration has no advantage over the oral route. Clinical effects were similar with both routes; there was a trend towards a faster onset of sedation with oral clonidine. Clonidine premedication causes light sleep, which allows a steal-induction in 60% of patients.
Almenrader
Nicole
N
Department of Anaesthesia and Intensive Care Medicine, University of Rome La Sapienza, Rome, Italy. nicalm@tiscali.it
Passariello
Maurizio
M
Coccetti
Bruno
B
Haiberger
Roberta
R
Pietropaoli
Paolo
P
D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage*; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D011292:Premedication
D006993:Hypnotics and Sedatives; D003000:Clonidine