Intravenous clonidine infusion in infants after cardiovascular surgery.
BACKGROUND
The aim of this study was to investigate the hemodynamic profile and heart rhythm in infants who were given intravenous clonidine infusion after prolonged analgesia/sedation following cardiac surgery.


METHODS
This is a single center retrospective review. A total of 542 cardiovascular surgical procedures in infants aged 0-24 months with congenital heart disease were performed between 01/2003 and 12/2005 at the Deutsches Herzzentrum in Berlin. The majority received no long-term analgesia/sedation, but 50 (9%) of these infants received clonidine (dosed at 0.18-3.6 microg.kg(-1).h(-1)) for sedation and to reduce withdrawal symptoms such as CNS hyperactivation, hypertension, tachycardia, and fever. The hospital records of these infants were studied.


RESULTS
Fifty infants (median age 5.0 months, median body weight 5.3 kg, 32 males/18 females) received prolonged analgesia/sedation to ensure hemodynamic stability. Clonidine infusion started on day 5 (median) after surgery. During clonidine treatment we found an age-related normalized profile of hemodynamic parameters with a reduction of heart rate and mean arterial pressure from the upper norm to the mean within 24 h (P < 0.001). In no case did clonidine cause low blood pressure resulting in additional therapy to reach the target blood pressure. There were no adverse effects on cardiac rhythm, especially no onset of atrioventricular block. Midazolam, fentanyl, and other opioids could be ended on day 4 of clonidine treatment.


CONCLUSIONS
Although off-label, it is feasible to use clonidine infusions in infants in the PICU setting after cardiac surgery without hemodynamic problems arising.
Pohl-Schickinger
Anja
A
Department of Neonatology, University Hospital Charité, Berlin, Germany. anja.pohl@charite.de
Lemmer
Julia
J
Hübler
Michael
M
Alexi-Meskishvili
Vladimir
V
Redlin
Matthias
M
Berger
Felix
F
Stiller
Brigitte
B
D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature; D003000:Clonidine / Q000008:administration & dosage*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D003000:Clonidine; D008874:Midazolam; D005283:Fentanyl