Safety of Intrathecal Clonidine as an Adjuvant to Spinal Anesthesia in Infants and Children
Pediatric Anesthesia
Submitted September 2025 by Dr David Roche
Read by 13 Journal Watch subscribers
This retrospective chart review explores the safety of intrathecal clonidine in infants and children up to 3 years of age who received spinal anaesthesia.
Methods
In this single centre study the authors conducted a search of the electronic medical record to identify paediatric patients who had received spinal anaesthesia with intrathecal clonidine. Demographics, procedure details and several safety outcomes were captured, these included:
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Oxygen desaturation defined as O2 Sats <92%
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The need for supplemental oxygen
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Bradypnea or apnoea
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Need for bag-valve-mask ventilation.
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Bradycardia (defined as heart rate ≤ 80 beats per minute)
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Hypotension (defined as systolic blood pressure (sBP) ≤ 60 mmHg)
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Clinical need for the administration of fluid boluses or vasoactive/anticholinergic medications
The typical anaesthetic agent used was described as 1 mg/kg (up to 1.2 mL) of 0.5% isobaric bupivacaine with epinephrine 1:200000 and 1 μg/kg of clonidine
Results
The cohort included 1420 patients who received spinal anaesthesia with intrathecal clonidine between 2016 and 2022. The a median age was 7 months (ranging from newborn to 3 years). 98% of patients were males. 5.3% of patients required conversion to general anaesthesia and 26.6% of patients required additional sedation intraoperatively. From a safety perspective the authors report intraoperative bradycardia in 2% of patients and hypotension in 17% based on the parameters outlined above. 93% of patients were discharged home on the day of surgery with a median post operative time in the theatre suite of 82 minutes.
Discussion
This study describes a large cohort of patients who received spinal anaesthesia with adjuvant intrathecal clonidine. Clonidine is used to prolong the duration of spinal block. The authors report no significant adverse events and based on their defined safety parameters suggest that clonidine is a safe adjuvant to spinal anaesthesia.
They acknowledge a number of limitations to this retrospective study – particularly the lack of data related to gestational age at birth or corrected post conceptual age on the day of surgery. Given the wide age range of the cohort reviewed, care should be taken when applying the reported safety profile to the pre-term or ex-pre term infant; the authors do however reference a study by Rochette et al which found no significant adverse events when spinal anaesthesia with 1mcg/kg of clonidine was administered to infants <60 weeks post conceptual age.
Furthermore, the definitions of bradycardia and hypotension in this study were fixed and applied to patients across a wide age range where physiological norms differ. This may have led to errors in the identification of adverse events.
Take Home Message
This paper provides a detailed description of a spinal anaesthesia program which utilizes adjuvant clonidine in infants and young children, with a high proportion of patients being discharged home on the same day. Given the wide age range of included patients, care should be taken when applying the reported safety profile to the neonate or ex-preterm infant.
