Clonidine in paediatric anaesthesia.

PURPOSE OF REVIEW: This review aims to summarize results of recently published studies concerning clonidine application in paediatric anaesthesia, to analyse trends in these studies, and to discuss perspectives of the perioperative use of clonidine for children.

RECENT FINDINGS: Reassessment of clonidine premedication has revealed that oral clonidine is inferior to midazolam for preoperative sedation. Oral or intravenous clonidine has been successfully used for the prevention of sevoflurane-induced agitation during emergence from anaesthesia. Peripheral injection or caudal (epidural) administration of clonidine prolonged the duration and enhanced the quality of postoperative analgesia by local anaesthetics without severe side effects. However, some negative results concerning potentiation of postoperative analgesia with clonidine have been reported.

SUMMARY: Clonidine may be less favored than midazolam as premedication for children because of inferior clonidine-induced sedation. Additional comparative studies are required, however, to confirm this finding. On the other hand, clonidine-induced analgesia may well be useful and find wide application in paediatric anaesthesia. Prospective multicentre trials using a larger number of patients will be needed to verify the usefulness of caudal clonidine for postoperative pain relief. Prophylactic use of clonidine against sevoflurane-induced agitation may represent a new and promising application. Assessment of the efficacy of clonidine in potentiating regional anaesthesia/analgesia by local anaesthetics in children also needs more investigation. Moreover, it may be worthwhile to try new successful applications demonstrated in adults for paediatric anaesthesia.