Safety of Intrathecal Clonidine as an Adjuvant to Spinal Anesthesia in Infants and Children.

Introduction: Preliminary clinical studies have demonstrated that clonidine is an effective adjuvant to spinal anesthesia in neonates and infants. However, the studies conducted previously have had a limited cohort size of 80-100, potentially limiting an accurate measure of its safety.

Methods: The current study retrospectively examines our 5-6-year experience with clonidine as an adjuvant to spinal anesthesia in a large cohort of neonates and infants.

Results: The study cohort included 1420 patients ranging in age from newborn to 36 months (median age 7 months). Ninety-five percent of the patients tolerated spinal anesthesia without requiring conversion to general anesthesia, and over 73% of the patients did not require any additional intraoperative sedation. Hypotension (sBP ≤ 60 mmHg) was the most common intraoperative event (17%) with one patient requiring the administration of an anticholinergic agent for bradycardia. No serious intraoperative adverse events were noted. Post Anesthesia Care Unit (PACU) Phase I was bypassed in 75% of cases, and the postoperative admission rate was 7%, with the majority (85%) being planned admissions. Fifty-six patients (4%) returned to the hospital during the first seven postoperative days, primarily for surgical concerns.

Conclusions: Based on this retrospective, observational study, clonidine appears to be a safe adjuvant to spinal anesthesia for ambulatory surgical procedures in infants and children. We observed a low incidence of intraoperative and postoperative complications.