Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial

This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane. Sixty-eight ASA I–II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg−1, clonidine 2 µg kg−1, and clonidine 4 µg kg−1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg−1) and rectal paracetamol (30 mg kg−1). During the first postoperative hour, children were evaluated using a modified ‘objective pain scale’. Only the 4 µg kg−1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 µg kg−1 group displayed agitation (25%) than in the midazolam group (60%) (P = 0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups. In comparison with midazolam, clonidine 4 µg kg−1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.