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Clonidine in pediatric anesthesia

the new panacea or a drug still looking for an indication?

Afshari, Arash

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 327–333
doi: 10.1097/ACO.0000000000000724
PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen
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Purpose of review Clonidine, an α2-receptor agonist is a widely used drug in pediatrics with a large scope of indications ranging from prevention of postoperative emergence agitation, analgesia, anxiolysis, sedation, weaning to shivering. In the era of ‘opioid-free’ medicine with much attention be directed toward increasing problems with opioid use, clonidine due to its global availability, low cost and safety profile has become an even more interesting option.

Recent findings Increasing evidence from randomised clinical trials support the use of clonidine in healthy children in the perioperative setting. Clonidine appears to significantly reduce postoperative emergence agitation, opioid consumption, shivering, nausea and vomiting. In addition, emerging evidence support the use of clonidine for sedation of critically ill children in ICUs. In this review, the current evidence for clonidine in pediatrics is described and analyzed including a meta-analysis for prevention of emergence agitation.

Summary Clonidine appears a safe and beneficial drug with moderate to high-quality evidence supporting its use in pediatric anesthesia. However, for some indications and populations such as children younger than 12 months old and those with hemodynamic instability, there is an urgent need for high-quality trials.

Department of Pediatric and Obstetric Anesthesia, Rigshospitalet, Juliane Marie Center, University of Copenhagen, Copenhagen Ø, Denmark

Correspondence to Arash Afshari, MD, PhD, Department of Pediatric and Obstetric Anesthesia, Rigshospitalet, Juliane Marie Center, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Tel: +45 3545 8749; e-mail: arash.afshari@regionh.dk

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