Clonidine: Improving preoperative sedation
A Clark, T Geary
University Hospital Corsshouse, Kilmarnock, UK.
Andrewclark7@nhs.net
Preoperative anxiety in children can lead to difficulties inducing
anaesthesia safely. Moreover, this can result in maladaptive behaviour
in the immediate and delayed postoperative period. Use of a sedative
premedication is one component of a multimodal approach to prevent
this [1]. Traditionally oral midazolam has been the agent of choice
however, this has certain disadvantages: a bitter taste, a small window
of optimum sedation and potentiates opiate induced respiratory
depression. Clonidine, an alpha 2 agonist, is tasteless, has a
significantly longer therapeutic window, is an analgesic and reduces
emergence agitation, post operative nausea and vomiting and volatile
anaesthetic agent requirements [2]. We aimed to survey our
department’s knowledge of clonidine and to develop a local health
board approved guideline to facilitate its safe and effective use in our
hospital.
Methods
An online survey was sent to all anaesthetic consultants (n=28) in
University Hospital Crosshouse. An Oral Pre-operative Sedation for
Children Undergoing Anaesthesia (<16 years) was developed by the
authors and presented to the NHS Ayrshire and Arran drugs and
therapeutics committee for approval.
Results
Nineteen consultants completed the survey (response rate of 68%).
Fourteen (74%) stated they had not previously used clonidine for
preoperative sedation in children. Eight (42%) did not know the
recommended dose. The remaining eleven stated a variety of doses
ranging from 1 – 5 micrograms per kilogram. Eleven consultants were
aware of advantages of clonidine over midazolam. Fourteen (74%)
stated they would be more likely to use clonidine for preoperative
sedation if local guidelines were available. The submitted guideline
(see figure 1) was accepted for use on the 20th February 2015.
Clonidine
Oral
Dose
Time to
onset
Peak
effect
Duration
of action
Cautions
4 mcg
/kg
30-60
mins
1–2
hours
Prolonged:
expect
post op
sedation
Bradyarrhythmias
Figure 1: Clonidine for perioperative sedation (adapted from Oral
Pre-operative Sedation for Children Undergoing Anaesthesia (<16
years) Guideline, NHS Ayrshire and Arran, Feb 2015)
Discussion
Clonidine has clear benefits for use as a preoperative sedative. Our
survey demonstrates a lack of local knowledge regarding its optimum
use. The development of our local preoperative sedation guideline has
provided a safe foundation to facilitate the adoption of clonidine into
our routine practice.
References
1. Tan L, Meakin GH. Anaesthesia for the uncooperative child.
Continuing Education in Anaesthesia, Critical Care & Pain
2010; 10(2): 48-52.
2. Bergendhal H, Lonngvist PA, Eksborg S. Clonidine in paediatric
anaesthesia: review of the literature and comparison with
benzodiazepines for premedication. Acta anaesthesiologica
scandinavica; 2006; 50(2): 135-143.