Journal: Paediatr Anaesth 18(1):71-73, 2008
Reprint: Department of Anesthesiology, University of North Carolina Hospitals, 2201 North Wing, CB# 7010, Chapel Hill, NC 27599-7010 (MJ Stella, MD) LE.03 JA0903/003 ©2009
Faculty Disclosure: Abstracted by L. Easley, who has nothing to disclose.
Clonidine is experiencing increasing use in the pediatric population as a sedative and analgesic because of its central α2-adrenergic agonism. Little experience with intranasal administration of clonidine has been published. The authors report three cases of preoperative use of intranasal clonidine in pediatric patients. The first patient was a 5-yr-old male with Ehlers-Danlos syndrome, attention deficit/ hyperactivity disorder, asthma and nonspecific platelet dysfunction who presented as an outpatient for full mouth dental rehabilitation. After receiving midazolam the patient became agitated and began having an acute delusional reaction with hallucinations. After administering 20 mcg clonidine intranasally to attempt to sedate the child, the patient experienced complete resolution of his agitation within 5 min. The second patient was a 4-year-old, child with epidermolysis bullosa who presented for esophageal dilation. He was offered the option of intranasal clonidine, to which he agreed. Sedation was noted by the father within 5 min. The third patient was a 3-month-old male with posterior urethral valves who presented for fulguration. Upon arrival in the precare suite, his blood pressure was 120/83 mmHg, and he appeared agitated and uncomfortable. He was given intranasal clonidine and within 2 min was relaxed and subjectively much calmer by his mother’s report.
α2-Agonists offer benefits such as decreased sympathetic tone, attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery, reduced anesthetic and opioid requirements and sedation and analgesia. Midazolam intranasally has been associated with nasal burning, postoperative agitation, behavioral disturbances and amnesia, while clonidine has the advantages of analgesia, no nasal burning, reduced postoperative confusion after sevoflurane anesthesia and no respiratory depression. In this case series, intranasal clonidine offered benefits specific to each patient.
These cases indicate that 1-2 mcg/kg of intranasal clonidine may be useful for selected patients with specific indications. Intranasal clonidine is well tolerated by the patient and appears to have a very rapid onset. Further pediatric studies are needed to determine pharmacokinetic and pharmacodynamics profiles and to determine its efficacy as both a premedication and as a treatment of perioperative agitation in children. |
