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 μg 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 μg 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 μg kg⁻¹ (group 1), 0.25% bupivacaine (0.75 ml kg⁻¹) and clonidine 0.75 μg 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 μg 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.