Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial.

Author(s): Tazeroualti N, De Groote F, De Hert S, De Ville A, Dierick A, Van der Linden P

Affiliation(s): Department of Anaesthesia, CHU-Brugmann - HUDERF, 4, Place Van Gehuchten, B-1020 Brussels, Belgium.

Publication date & source: 2007-05, Br J Anaesth., 98(5):667-71. Epub 2007 Apr 7.

Publication type:

BACKGROUND: /st> 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: /st> 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 (O(2)/N(2)O: 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: /st> 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: /st> In comparison with midazolam, clonidine 4 microg kg(-1) reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.