Steal induction in preschool children: is melatonin as good as clonidine? A prospective, randomized study

Abstract

Melatonin was effective for steal induction in 75% of children compared to 88% of children who had clonidine. Melatonin resulted less effective when administered early in the morning.

A systematic review of peri‐operative melatonin

“…Melatonin reduced the intravenous anaesthetic dose [23,24] but not the dose of sevoflurane [30]. Melatonin was less effective than clonidine in facilitating successful 'steal' induction of anaesthesia in 87 children [31]. Melatonin had no effect on complication rates of 36 liver resection patients [32].…”

“…One study included a control group in which patients did not receive a placebo [23]. Participants had various operations: abdominal [15][16][17]25, Full-text studies excluded (n = 17) -10 studies did not investigate surgical patients -3 studies were protocol studies -2 studies were not randomised -2 studies used melatonin only in combination with other drug interventions 32]; dental [27]; gynaecological [5,6,18,19,30]; ophthalmological [4,14]; orthopaedic [12]; thoracic [28,29]; urological [13]; vascular [26]; and mixed [20][21][22][23][24]31]. The anaesthetic techniques included: general anaesthesia [13,[15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32]; intravenous regional anaesthesia [12]; neuraxial block [5,6,20,…”

“…The rationale is that this might reduce peri-operative stress and anxiety, including subsequent anaesthetics. Melatonin has not been compared with placebo, but appears to be inferior to clonidine [31].…”

Melatonin and clonidine premedication has similar impact on the pharmacokinetics and pharmacodynamics of propofol target controlled‐infusions

“…Similarly to Kain et al, our analysis seems to indicate that the anxiolytic effect of melatonin is lesser than that of clonidine. However, further studies are required on this field taking into account the influence of dosing time of melatonin efficacy, because literature data suggests that the anxiolytic effect of this sleep hormone may be lesser if it is given during the morning hours . Our aim was to understand the usefulness of melatonin as a premedicant for routine clinical practice and chronobiological aspect was not of our concern.…”

Melatonin

“…Clinical studies in these areas are very limited, but melatonin had only marginally beneficial effects in major liver resection surgery (Nickkholgh et al, 2011). However, it has been shown to be nearly as effective as clonidine as an agent for sleep induction preceding surgical anesthesia in children aged 1-5 years (Almenrader et al, 2013). Moreover, melatonin administration has been reported to lead to improved outcome following organ transplant procedures (Liu et al, 2014) and neonatal surgery (Gitto et al, 2004).…”