The Efficacy of Oral Clonidine and Oral Midazolam in Prevention of Emergence Agitation in Post-Operative Pediatric

Emergence Agitation (EA) is a common postoperative problem in children. It is characterized by the change in perception of the environment with signs of disorientation، hypersensitivity to stimuli، and hyper active motor behavior. The oral premedication is widely used in pediatric anesthesia to reduce the preoperative anxiety. Midazolam is currently the most commonly used premedicant in this regard; and somehow using the clonidine showed good results too. The aim of the present study was to compare the efficacy of oral Midazolam and oral Clonidine in prevention of EA among the post-operative pediatrics.

In a double-blind randomized clinical trial، 127 children candidates for tonsillectomy and myringotomy were evaluated. Patients were divided into three groups: group M (n=42) received oral Midazolam (0. 5 mgkg-1) 30 min before operation; group C (n=43) received oral Clonidine (4 µkg-1) 30 min before operation; and group P (n=42) just received oral placebo in the same time. Agitation scores were recorded before and after the intervention.

The final agitation score was significantly lower in the M and C groups comparing with placebo group. In separate measurements، the mean agitation score were significantly lower in the C group comparing with the M group. The frequency of EA was significantly lower in M and C groups immediately after recovery comparing with placebo group but this rate was conversely higher in the M and C groups until 20 min after recovery. The mean time of recovery was significantly higher in M and C groups comparing with placebo group. Vital signs were somehow stable in C group comparing with M group. The mean duration of agitation was similar between the three groups (P>0. 05).

The oral Clonidine and Midazolam may reduce the severity of EA after operation in children; this finding is much stronger for Clonidine.