title: Incidence of bradycardia at arrival to the operating room after oral or intravenous premedication with clonidine in children.
abstract: BACKGROUND
  Clonidine has been advocated as a valid alternative for premedication in children but one of the few limitations is its association with reduced heart rate (HR), which thus raises the question of the safety of clonidine as premedication in children. The aim of this study was to investigate the incidence of bradycardia in children premedicated with oral or intravenous clonidine as compared to children not receiving pharmacologic premedication.
  
  
  METHODS
  An open, nonrandomized, observational study design was used. During the preoperative assessment visit the children were prescribed no premedication, intravenous or oral clonidine. On arrival to the operating room (OR) HR was recorded by connecting the patient to standard monitoring with pulseoximetry and/or Electrocardiogram. The primary outcome measure was the number of patients with a HR below 85% of the lower limit of the normal range (1st centile), which was defined as bradycardia that might need clinical intervention.
  
  
  RESULTS
  One thousand five hundred and seven patients were included in the analysis. 600 and 85 patients did not receive any premedication (Group 0), 305 patients received iv Clonidine (Group CIV), and 517 patients were given oral Clonidine (Group CPO). One patient in Group 0 (0.15%; 95% CI: 0-0.81%), none in Group CIV (0%; 95% CI: 0.00-0.98%), and 5 patients in Group CPO (0.97%; 95% CI: 0.31-2.24%) were observed to have a HR of <85% of the 1st centile.
  
  
  CONCLUSIONS
  The incidence of bradycardia following oral or intravenous premedication with clonidine in a pediatric population scheduled for anesthesia is low. Thus, it does not appear rational to refrain from using clonidine as premedication in children only due to fear of bradycardia.
authors.affiliation: Department of Physiology and Pharmacology, Section of Anaesthesiology & Intensive Care, Karolinska Institutet, Stockholm, Sweden.|Department of Pediatric Anesthesia and Intensive Care, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Larsson
authors.affiliation: Department of Pediatric Anesthesia and Intensive Care, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Eksborg
authors.affiliation: Department of Physiology and Pharmacology, Section of Anaesthesiology & Intensive Care, Karolinska Institutet, Stockholm, Sweden.|Department of Pediatric Anesthesia and Intensive Care, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Per-Arne
authors.initials: PA
authors.lastname: Lönnqvist
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D009873:Operating Rooms; D011229:Preanesthetic Medication / Q000009:adverse effects* / Q000379:methods
chemical_list: D000700:Analgesics; D003000:Clonidine
keywords: bradycardia; child; clonidine; premedication