Preoperative administration of multiple doses of clonidine may precipitate severe bradycardia, hypotension, and cardiac arrest during sevoflurane induction of anesthesia in children.
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Raises awareness of clonidine-related hemodynamic risks in pediatric anesthesia; hypothesis-generating and requires validation before practice change.
Clonidine is a frequently administered alpha2-adrenergic agonist which can decrease heart rate and blood pressure. We present a case of a 5-year-old child with cerebral palsy and seizure disorder, receiving clonidine for restlessness, who presented for placement of a baclofen pump. Without the knowledge of the medical personnel, the patient's mother administered three doses of clonidine during the evening before and morning of surgery to reduce anxiety. During induction of anesthesia, the patient developed bradycardia and hypotension requiring cardiac resuscitation. There are no previous reports of clonidine-associated cardiac arrest in a child undergoing induction of anesthesia.
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Goldfinger et al. (2006) studied this question.
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