ABSTRACT
The aim of this work was to study the effects of clonidine on the incidence and severity of agitation in preschool children after sevoflurane anesthesia and to determine if caudal clonidine has an advantage over i.v. route. This placebo controlled double blind study included 75 children aged 2-7 years admitted to Menoufyia University Hospital for repair of congenital hernia or hydrocele. Sevoflurane was used for induction and maintenance of anesthesia. Caudal epidural block was performed in all the children using 0.175% bupivacaine 1 ml/Kg. Children were randomized into five groups; Group I: clonidine 1 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. as a placebo. Group II: received caudal bupivacaine while clonidine 1 micro g/Kg was given i.v. Group III: clonidine 2 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. Group IV: received caudal bupivacaine while clonidine 2 micro g/Kg was given i.v. Group V: received caudal bupivacaine and normal saline was given i.v. A 3-point agitation score was used to determine the incidence and severity of agitation. Midazolam bolus injection was used to treat severe agitation. Incidence of agitation was significantly less in patients who received clonidine 2 micro g/Kg [0% in Group III and 6.7% in Group IV] compared to control group [73.3%]. The difference was not significant when clonidine 1 micro g/Kg [Group I and II] was used. The difference was not significant when caudal and i.v. clonidine groups were compared [Group I vs. Group II and Group III vs. Group IV]. Midazolam bolus to stop agitation was not needed at all in Group III or Group IV. No bradycardia, hypotension or hypoxemia was noted. We concluded that clonidine 2 micro g/kg body weight, caudally or i.v., significantly decreases the incidence and severity of agitation in children after sevoflurane anesthesia without added side effects