Clonidine in pediatric anesthesia

Afshari, Arash

doi:10.1097/aco.0000000000000724

Cited by 13 publications

(6 citation statements)

References 62 publications

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“…In addition to analgesia, clonidine reduces nausea, anesthesia requirements, and emergence delirium. Clonidine also reduces anesthesia induction time, oxygen consumption, and has myocardial protective qualities [ 3 , 4 ]. Recently, it has been shown to be similarly effective to midazolam in reducing postoperative negative behavioral changes [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, it has been shown to be similarly effective to midazolam in reducing postoperative negative behavioral changes [ 3 ]. The onset time for oral clonidine is 30–60 min, and the half life is around 12 h. The peak effects are within 60–90 min [ 4 ]. It also has an excellent safety profile with a very low incidence of bradycardia when dosed appropriately (less than 1%) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…It also has an excellent safety profile with a very low incidence of bradycardia when dosed appropriately (less than 1%) [ 5 ]. Other side effects include hypotension, although existing data suggest that this clonidine induced hypotension does not lead to any cardiac adverse effects [ 4 ]. There is one case report of cardiac arrest in a patient with multiple comorbidities who received three doses of clonidine prior to surgery and developed hypotension and bradycardia on induction of anesthesia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Pre-Admission Oral Clonidine to Reduce Severe Pre-Operative Anxiety in Pediatric Patients with Behavioral Disorders: A Case Series

Verdecchia,

Nelson,

White

et al. 2024

Children

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Controlling preoperative anxiety is necessary in pediatric patients to avoid adverse effects such as emergence delirium, behavioral problems, post-traumatic stress disorder, anxiety prior to future procedures, and increased analgesic doses in the recovery room. Some patients, especially ones with behavioral issues, have a difficult time arriving at the hospital. Medications given at home can be helpful. We describe a case series of six patients who received pre-admission oral clonidine prior to arrival to the hospital. The patients were all able to enter the hospital without difficulty and the families reported less anxiety and more cooperation subjectively compared with previous experiences. Transient intraoperative hypotension was a side effect of oral clonidine, with no long-term sequelae.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre-Admission Oral Clonidine to Reduce Severe Pre-Operative Anxiety in Pediatric Patients with Behavioral Disorders: A Case Series

Verdecchia,

Nelson,

White

et al. 2024

Children

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“…Clonidine is often used off‐label for different indications, including sedation, pain, and prevention of emergence agitation 8–11 . Several clinical trials have previously found beneficial effects of clonidine as an adjunctive agent for the prevention of emergence agitation in children over 1 year 3,12 . The PREVENT AGITATION trial in children 1–5 years of age found a decrease in episodes of emergence agitation in the clonidine (3 μg/kg) group compared with the placebo group (RR 0.56, 95% CI: 0.43–0.73) 13 .…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] Several clinical trials have previously found beneficial effects of clonidine as an adjunctive agent for the prevention of emergence agitation in children over 1 year. 3,12 The PREVENT AGITATION trial in children 1-5 years of age found a decrease in episodes of emergence agitation in the clonidine (3 μg/kg) group compared with the placebo group (RR 0.56, 95% CI: 0.43-0.73). 13 However, there is little published evidence on emergence agitation in children under 1 year, 14 and it is difficult to extrapolate dose recommendations from older age groups due to developmental considerations.…”

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confidence: 99%

Clonidine for preventing emergence agitation in infants (PREVENT AGITATION II): Protocol and statistical analysis plan

Garioud

Nielsen

Falcon

et al. 2023

Acta Anaesthesiol Scand

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Background Emergence agitation is a common clinical condition in children. Symptoms pertaining to the spectrum of early postoperative negative behavior typically occur upon emergence from anesthesia. Clonidine is an effective adjunctive agent for the prevention of emergence agitation in children, but evidence in the smallest age groups is sparse We aim to investigate the efficacy and safety of an intraoperative bolus of intravenous clonidine for preventing emergence agitation in children 3–12 months of age. Methods This is a randomized, placebo‐controlled, double‐blind trial. We will enroll 320 patients aged 3–12 months who have been scheduled for general anesthesia maintained with sevoflurane and opioid. The randomization is parallel and stratified by age group, sex, and site. The investigational medicinal product will be administered intravenously ~20 min before the anticipated end of the surgical procedure. The intervention is clonidine 3 μg/kg and placebo is isotonic saline in a corresponding volume. Results The primary outcome is the incidence of emergence agitation as assessed on the Watcha scale, that is, any Watcha score >2 during participants' stay in the postanesthetic care unit. Secondary outcomes are the proportion of participants with postoperative pain, with postoperative nausea and vomiting, and a composite safety outcome. Statistical analysis will be conducted according to the Statistical Analysis Plan with the intention‐to‐treat population for our primary analyses. Conclusion The PREVENT AGITATION II trial will contribute valuable knowledge on efficacy for the prevention of emergence agitation and safety in infants.

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Pharmacology of Anesthetic Agents in Children

Sims

Thompson

2019

A Guide to Pediatric Anesthesia

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Clonidine in pediatric anesthesia

Cited by 13 publications

References 62 publications

Pre-Admission Oral Clonidine to Reduce Severe Pre-Operative Anxiety in Pediatric Patients with Behavioral Disorders: A Case Series

Pre-Admission Oral Clonidine to Reduce Severe Pre-Operative Anxiety in Pediatric Patients with Behavioral Disorders: A Case Series

Clonidine for preventing emergence agitation in infants (PREVENT AGITATION II): Protocol and statistical analysis plan

Pharmacology of Anesthetic Agents in Children

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