Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication

Abstract

Background: Children undergoing anaesthesia and surgery can experience significant anxiety and distress during the peri‐operative period, but whether routine premedication is necessary is currently debated. Benzodiazepines are the most frequently used drugs as premedication in paediatric anaesthesia. In the US, 50% of young children undergoing surgery receive premedication and midazolam is the most frequently used drug in this context (1). Nishina and coworkers (2) concluded in a review article in 1999 that clonidine, administered via an oral, rectal, or caudal route, is a promising adjunct to anaesthetics and analgesics to enhance quality of peri‐operative management in infants and children. Later publications also support the use of clonidine for premedication (3–6). The aim of this communication is to review the use of clonidine in paediatric anaesthesia and to propose clonidine as a promising alternative to midazolam. Clonidine is associated with a number of beneficial effects in the context ofanaesthesia both in adults and children. Why clonidine is not routinely use in clinical practice despite the massive publication list is to a large extent due to the lack of marketing efforts from the pharmaceutical industry since multiplegeneric preparations are now readily available on most markets. Midazolam is also associated with a number of beneficial effects, but is far from an ideal premedicant in children, especially with regards to the amnesia, confusion and long term behavioural disturbances. Clonidine has contrary to midazolam no effect on respiration. We believe that clonidine is a good alternative to midazolam as premedication in infants and children.

A comparative study of dexmedetomidine vs midazolam for sedation and hemodynamic changes during tympanoplasty and modified radical mastoidectomy

“…impairment, amnesia, and respiratory depression. 4,5 New drugs, such as the α 2 -agonists, have emerged as alternatives for iv sedation. Dexmedetomidine is a highly selective α 2 -adrenoceptor agonist that has sedative and analgesic effects.…”

Oral premedication for pediatric anaesthesia: a comparison between midazolam and clonidine

“…7,8 Its beneficial effects in adult are well documented and this has encouraged the study of this drug in paediatric anaesthesia setting as well.…”

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anaesthesia - A Randomized Controlled Trial

“…Although amnesia is considered an advantage by some authorities, it has also been regarded as a possible disadvantage by others (15) . Clonidine (16) , an α2-agonist, has been suggested as another option for premedication in children and previous studies have shown it to be equally as effective as midazolam. Oral (17,18) clonidine premedication has also been shown to reduce the incidence of sevoflurane induced emergence agitation.…”