title: Effect of caudal clonidine on emergence agitation and postoperative analgesia after sevoflurane anaesthesia in children: Randomised comparison of two doses.
abstract: OBJECTIVE
  Sevoflurane, a popular inhalational anaesthetic for children, has been associated with significant emergence agitation in the recovery phase. This study was intended to compare two doses of caudal clonidine added to ropivacaine 0.2% in order to decide on the optimal dose for prevention of sevoflurane induced emergence agitation (EA) and to get a meaningful prolongation of postoperative analgesia with minimal side effects.
  
  
  METHODS
  Sixty-one children aged 1-7 years (American Society of Anaesthesiologists physical status I-II) received standardized general anaesthesia with inhaled sevoflurane and caudal epidural block with 0.2% ropivacaine 1 ml/kg for sub-umbilical surgeries. They were assigned randomly to two groups: (I) clonidine 1 μg/kg added to caudal ropivacaine; (II) clonidine 2 μg/kg added to caudal ropivacaine. EA and postoperative analgesia were assessed using pain/discomfort scale score and face, legs, activity, cry, consolability (FLACC) score respectively.
  
  
  RESULTS
  EA was observed in 8 children (26.6%) in group I when compared to only 2 children (6.4%) in group II after first 15 min postoperatively. Incidences of EA at 15 min, as well as total incidence of agitation, were both significantly lower in group II when compared to group I with P < 0.05. Duration of analgesia in group I (12 [8-20] h) and group II (16 [8-20] h) was statistically comparable (P > 0.05). There was no difference in the incidence of sedation or complications.
  
  
  CONCLUSIONS
  Caudal clonidine 2 μg/kg added to 0.2% ropivacaine 1 ml/kg is suggested to be the optimal dose, for prevention of EA and meaningful prolongation of postoperative analgesia with minimal side-effects.
authors.affiliation: Department of Anaesthesia and Critical Care, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Anudeep
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Anaesthesia and Critical Care, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesia and Critical Care, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Rajan B
authors.initials: RB
authors.lastname: Godwin
keywords: Caudal clonidine; emergence agitation; optimal dose; postoperative analgesia; sevoflurane