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

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 mu g 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 mu g kg(-1)) in reducing the incidence of sevoflurane-induced agitation in preschool children undergoing urogenital and lower limb surgery. Methodology A double-blind study was conducted comparing 0.25% (0.75 ml kg(-1)) bupivacaine and clonidine 1 mu g kg(-1) (group 1), 0.25% bupivacaine (0.75 ml kg(-1)) and clonidine 0.75 mu g 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. Result 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. Conclusion Caudal clonidine at a lower dose (1 mu g 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. Eur J Anaesthesiol 2011;28:329-333 Published online 13 December 2010