Review Article: Expert’s Opinion
Clonidine in paediatric anaesthesia: review of the
literature and comparison with benzodiazepines for
premedication
H. BERGENDAHL1, P-A. LÖNNQVIST2 and S. EKSBORG3
1Department of Anaesthesia, Intensive, and Pain Care, Karolinska University Hospital, Huddinge, Department of Paediatric Anaesthesia and
Intensive Care, 2Astrid Lindgrens Children’s Hospital and 3Karolinska Pharmacy, and Department of Woman and Child Health, Childhood Cancer
Research Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Background: Children undergoing anaesthesia and surgery can
experience significant anxiety and distress during the peri-
operative period, but whether routine premedication is neces-
sary is currently debated.
Benzodiazepines are the most frequently used drugs as pre-
medication in paediatric anaesthesia. In the US, 50% of young
children undergoing surgery receive premedication and mida-
zolam is the most frequently used drug in this context (1).
Nishina and coworkers (2) concluded in a review article in
1999 that clonidine, administered via an oral, rectal, or caudal
route, is a promising adjunct to anaesthetics and analgesics to
enhance quality of peri-operative management in infants and
children. Later publications also support the use of clonidine for
premedication (3—6).
The aim of this communication is to review the use of cloni-
dine in paediatric anaesthesia and to propose clonidine as a
promising alternative to midazolam.
Clonidine is associated with a number of beneficial effects in
the context ofanaesthesia both in adults and children. Why
clonidine is not routinely use in clinical practice despite the
massive publication list is to a large extent due to the lack of
marketing efforts from the pharmaceutical industry since multiple-
generic preparations are now readily available on most markets.
Midazolam is also associated with a number of beneficial
effects, but is far from an ideal premedicant in children, especially
with regards to the amnesia, con