Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. a prospective, randomized, controlled trial.
BACKGROUND
This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane.


METHODS
Sixty-eight ASA I-II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg-1, clonidine 2 microg kg-1, and clonidine 4 microg kg-1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg-1) and rectal paracetamol (30 mg kg-1). During the first postoperative hour, children were evaluated using a modified 'objective pain scale'.


RESULTS
Only the 4 microg kg-1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 microg kg-1 group displayed agitation (25%) than in the midazolam group (60%) (P=0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups.


CONCLUSIONS
In comparison with midazolam, clonidine 4 microg kg-1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.
Tazeroualti
N
N
Department of Anaesthesia, CHU-Brugmann-HUDERF, 4, Place Van Gehuchten, B-1020 Brussels, and University Hospital Antwerp, Edegem, Belgium.
De Groote
F
F
De Hert
S
S
De Villé
A
A
Dierick
A
A
Van der Linden
P
P
D000284:Administration, Oral; D000700:Analgesics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008874:Midazolam / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology / Q000517:prevention & control*; D000077149:Sevoflurane
D000700:Analgesics; D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D003000:Clonidine; D008874:Midazolam