Canadian Journal of Anaesthesia

, Volume 42, Issue 11, pp 977–981

Oral clonidine premedication reduces vomiting in children after strabismus surgery

  • Katsuya Mikawa
  • Kahoru Nishina
  • Nobuhiro Maekawa
  • Migiwa Asano
  • Hidefumi Obara
Reports of Investigation

Abstract

This is a prospective randomized double-blind trial conducted to determine whether preoperative orally administered clonidine causes or potentiates postoperative vomiting in 140 children (3–12 yr) undergoing strabismus surgery. They were all inpatients and classified randomly into four groups (n = 35 each); placebo (control), diazepam 0.4 mg · kg−1, clonidine 2 μg · kg−1, and clonidine 4 μg · kg−1. These agents were administered 93–112 min (mean: 100 min) before the anticipated time of induction of anaesthesia. All children received inhalational anaesthesia with halothane and nitrous oxide in oxygen.’ Muscle relaxation in all patients was obtained with vecuronium and residual neuromuscular blockade was antagonized with neostigmine and atropine before tracheal extubation. Diclofenac suppository was prescribed to prevent postoperative pain. No opioids or postoperative antiemetics were administered. All children remained in hospital for two days postoperatively. The incidence and frequency of vomiting were compared in the groups with Kruskall-Wallis Rank test. Clonidine 4 μg · kg−1 caused a lower incidence and frequency of vomiting than did placebo and diazepam (incidence and frequency: 11% and 1,37% and 3, and 34% and 2 in clonidine 4 μg · kg−1, placebo, and diazepam, respectively; P < 0.05 for clonidine 4 μg · kg−1 vs placebo and diazepam). However, lowdose clonidine was ineffective. These data suggest that preanaesthetic medication with clonidine 4 μg · kg−1 may be useful for preventing emesis following strabismus surgery. This property of clonidine indicates that it may be superior to other sedative premedicants such as diazepam and midazolam.

Key words

anaesthesia: paediatric premedication: diazepam, clonidine sympathetic nervous system: alpha-adrenergic agonist, clonidine vomiting: antiemetics, nausea 

Résumé

Cette étude randomisée et à double insu réalisée chez 140 enfants (âgés de trois à douze ans) visait à déterminer si la clonidine orale administrée à la période préopératoire provoquait ou exagérait les vomissements postopératoires opérés pour strabisme. Les enfants étaient tous hospitalisés et ont été répartis aléatoirement entre quatre groupes (n = 35 par groupe): placebo (contrôle), diazepam 0,4 mg · kg−1, clonidine 2 μg · kg−1 et clonidine 4 μg · kg−1. Ces produits ont été administrés 93–112 min (moyenne 100 min) avant le moment anticipé de l’induction. La relaxation musculaire a été réalisée chez tous les patients avec du vécuronium et la curarisation résiduelle neutralisée avec de l’atropine et de la néostigmine avant l’extubation. On n’a administré ni morphinique ni d’antiémétique aux périodes pré-et postopératoire. Tous les enfants sont demeurés deux jours à l’hôpital après l’opération. L’incidence et la fréquence des vomissements ont été comparées entre les groupe avec le test de Kruskall-Wallis Rank. La clonidine 4 μg · kg−1 a provoqué une incidence et une fréquence inférieures à celles du placebo et du diazépam (incidence et fréquence: 11% et 1,37% et 3, et 34% et 2 pour clonidine 4 μg · kg−1, placebo et diazépam respectivement; P < 0,05 pour clonidine 4 μg · kg−1 vs placebo et diazépam). Cependant, la clonidine à faible dose n’a pas eu d’effets. Ces données suggèrent que la clonidine en prémédication peut être efficace pour prévenir les vomissements après une intervention pour strabisme. La clonidine pourrait être supérieure aux autres pr⨼édications telles que le diazépam et la midazolam.

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Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • Katsuya Mikawa
    • 1
  • Kahoru Nishina
    • 1
  • Nobuhiro Maekawa
    • 1
  • Migiwa Asano
    • 1
  • Hidefumi Obara
    • 1
  1. 1.Department of AnaesthesiologyKobe University School of MedicineChuo-kuJapan

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