title: Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study.
abstract: BACKGROUND
  Sevoflurane is commonly used as an inhalational induction agent in paediatric patients. Emergence agitation is a common post-operative problem in young children who have received sevoflurane. Clonidine has proven to be effective in reducing the incidence of post-operative agitation at a higher dose (3 and 2 μg kg⁻¹). It has some dose-dependent disadvantages, prominently bradycardia, hypotension and respiratory impairment.
  
  
  OBJECTIVE
  The authors conducted a study to evaluate the effectiveness of low-dose caudal clonidine (1 μg kg⁻¹) in reducing the incidence of sevoflurane-induced agitation in preschool children undergoing urogenital and lower limb surgery.
  
  
  METHODS
  A double-blind study was conducted comparing 0.25% (0.75 ml kg⁻¹) bupivacaine and clonidine 1 μg kg⁻¹ (group 1), 0.25% bupivacaine (0.75 ml kg⁻¹) and clonidine 0.75 μg kg⁻¹ (group 2), with 0.25% bupivacaine (0.75 ml kg⁻¹) alone (group 3). Ninety children of 1-5 years of American Society of Anesthesiologists I and II were randomly assigned into three groups. Post-operatively, patients were monitored for 1 h to observe emergence agitation, which was assessed with the help of Pain and Discomfort Scale.
  
  
  RESULTS
  Post-anaesthetic agitation was observed in two patients (6.6%) in group 1, eight patients (26.6%) in group 2 as compared to 12 patients (40%) in group 3 after 15 min of post-operative observation. The mean scores in group 1 at 15 and 30 min were significantly lower than those in group 3 (P value <0.05). None of the groups had showed any haemodynamic and respiratory compromise, either clinically and statistically.
  
  
  CONCLUSIONS
  Caudal clonidine at a lower dose (1 μg kg⁻¹) could be effective in reducing the incidence of sevoflurane-induced emergence agitation in children undergoing urogenital and lower limb surgery without any significant adverse effects.
authors.affiliation: Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India. dr.raktimghosh@gmail.com
authors.forename: Samhati Mondal
authors.initials: SM
authors.lastname: Ghosh
authors.forename: Radhika B
authors.initials: RB
authors.lastname: Agarwala
authors.forename: Maitree
authors.initials: M
authors.lastname: Pandey
authors.forename: Homay
authors.initials: H
authors.lastname: Vajifdar
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000763:Anesthesia, Caudal / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology / Q000517:prevention & control*; D000077149:Sevoflurane; D013519:Urogenital Surgical Procedures / Q000379:methods
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D003000:Clonidine; D002045:Bupivacaine