Does Intraoperative Clonidine Reduce Post Operative Agitation in Children?

BACKGROUND:

Clonidine is widely used off-label in children for several indications such as treatment and/or prevention of postoperative agitation when anaesthetised with Sevoflurane. However, the current level of evidence in support of Clonidine treatment for postoperative agitation in children remains limited. In addition, the pharmacokinetic profile of intravenous Clonidine in children is not well characterized for age-groups.

METHODS/DESIGN:

In this prospective multicentre double-blinded randomized clinical trial, the investigators aim to investigate the impact of intravenous (IV) Clonidine administered at the end of surgery, on the incidence and degree of postoperative agitation. Children will be assigned to either the intervention or the placebo group. The allocation will be carried out centrally and stratified based on age and trial-site, with152 patients allocated to each group. In the intervention group, 3 micrograms per kg of IV clonidine is administered approximately 20 minutes before the expected completion of the surgery (as assessed by the surgeon). In the control group; Saline (placebo) is injected in equal quantity during surgery at the same time. The drugs are concealed in identical blinded ampoules.

The primary outcome is postoperative agitation measured on the Watcha scale. Secondary outcomes include measurements of postoperative pain relief and adverse effects, including 30-day follow-up.

Twenty of the patients age 1-2 years and twenty age >2 years, with a peripheral venous access in place, will be allocated to drug assay sampling; enabling a compartmental PK analysis based on age group, using non-linear mixed effects models.

Inclusion criteria

• scheduled for surgery with Sevoflurane as the choice of anesthesia.

Exclusion criteria

• ASA classification >2
• Premedication with Clonidine
• Ex-premature (born before week 37+0 AND <60 weeks old)
• Intubated before anaesthesia and/or no plans for extubation after anaesthesia.
• Critical illness with haemodynamic instability.
• Active bleeding.
• Cancer.
• Cardiac diseases including arrhythmias.
• Malignant hyperthermia.
• Mental retardation.
• Neurological illness with agitation-like symptoms.
• Weight >50 kg.
• Allergy to Clonidine.
• Patients treated with methylphenidate / Concerta.