Effect of caudally administered clonidine on sevoflurane induced emergence agitation—A randomized trial

Abstract

Background and Aims: Emergence agitation (EA) is an unpleasant problem encountered in children following anesthesia with Sevoflurane. We studied the effectiveness of caudal epidural block (CEB) with ropivacaine 0.2% and clonidine two microgram per kilogram (mcg/kg) on the incidence of EA, with respiratory depression and hemodynamic variables as secondary end points. Material and Methods: Ninety children aged one to eight years undergoing infra umbilical surgeries were randomly allocated into two groups. Group RS: Ropivacaine 0.2% one ml/kg + . Saline one ml and Group RC: Ropivacaine 0.2% one ml/kg + Clonidine two mcg/kg made to one ml. They were then administered general anesthesia with endotracheal intubation followed by CEB using test drugs. Post surgery, EA was evaluated by Modified Richmond Agitation Scale at 15-minute intervals for one hour. The results were then analyzed using mean and standard deviation (SD), Chi square test, and Independent t test. Results: EA was significantly lower in group RC when compared to group RS (P < 0.0001). Group RC had 12 (28.5%) children with EA at 15 minutes compared to 35 (83.3%) children in Group RS. At 30 minutes, it was seen in five (11.3%) and 27 (64.2%) children in group RC and RS, respectively. No significant respiratory depression was noted in both groups. A significant decrease in heart rate was seen in Group RC (P < 0.001) but was not significant clinically. No adverse events were recorded in both the groups. Conclusion: Addition of clonidine (2mcg/kg) to ropivacaine 0.2% offers an advantage over 0.2% ropivacaine alone in decreasing the incidence of sevoflurane induced EA in children undergoing lower abdominal surgery without any adverse effects.

Electroencephalographic insights into the pathophysiological mechanisms of emergence delirium in children and corresponding clinical treatment strategies

“…In summary, these interventions alter the EEG during wakefulness through their respective sedative and analgesic effects, increase the power of spindle or alpha waves, reduce the connectivity of t the brain, so that the EEG during the emergence period will be closer to the natural awakening EEG changes, and render the childless perceptive to external stimuli and reduce CNS excitability, thereby preventing the occurrence of pediatric ED. Furthermore, other interventions such as colistin, benzodiazepines, melatonin, gabapentin ( Pinto Filho et al, 2019 ; Archana et al, 2022 ; Yang et al, 2022 ) and recorded maternal voice during emergence, and regional block can reduce the incidence of ED ( Byun et al, 2018 ; Zhong et al, 2018 ; Yang et al, 2020 ). Interestingly, after intravenous administration of clonidine to achieve sedation in healthy volunteers, their EEG showed a decrease in dominant alpha activity and an increase in delta oscillations ( Bischoff et al, 2004 ; Miyazaki et al, 2004 ).…”