Use of oral clonidine for sedation in ventilated paediatric intensive care patients

Sara Arenas-Lopez, Shelley Riphagen, Shane M. Tibby, Andrew Durward, Steve Tomlin, Graham Davies, Ian A. Murdoch

Research output: Contribution to journalArticle

Abstract

Objectives We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design Prospective, cohort study over a 72-h period. Setting Regional paediatric intensive care unit. Patients and participants Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation). Measurements and results Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3–5 mgrg/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95% confidence interval 1.0–1.8). Adequate sedation was achieved during 82% (837/1022 h) of the study period; however, this decreased to 70.3% when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine (P = 0.02) and lorazepam (P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia. Conclusions Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.
Original languageEnglish
Pages (from-to)1625-1629
Number of pages5
JournalIntensive care medicine
Volume30
Issue number8
Publication statusPublished - Aug 2004

Fingerprint

Lorazepam
Clonidine
Critical Care
Hypnotics and Sedatives
Morphine
Pediatrics
Respiratory Insufficiency
Pediatric Intensive Care Units
Bradycardia
Benzodiazepines
Hyperglycemia
Hypotension
Gas Chromatography-Mass Spectrometry
Opioid Analgesics
Cohort Studies
Pharmacokinetics
Prospective Studies
Confidence Intervals

Keywords

  • Clonidine
  • Sedation
  • Paediatric
  • Intensive care

Cite this

Arenas-Lopez, S., Riphagen, S., Tibby, S. M., Durward, A., Tomlin, S., Davies, G., & Murdoch, I. A. (2004). Use of oral clonidine for sedation in ventilated paediatric intensive care patients. Intensive care medicine, 30(8), 1625-1629.
Arenas-Lopez, Sara ; Riphagen, Shelley ; Tibby, Shane M. ; Durward, Andrew ; Tomlin, Steve ; Davies, Graham ; Murdoch, Ian A. / Use of oral clonidine for sedation in ventilated paediatric intensive care patients. In: Intensive care medicine. 2004 ; Vol. 30, No. 8. pp. 1625-1629.
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abstract = "Objectives We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design Prospective, cohort study over a 72-h period. Setting Regional paediatric intensive care unit. Patients and participants Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation). Measurements and results Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3–5 mgrg/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95{\%} confidence interval 1.0–1.8). Adequate sedation was achieved during 82{\%} (837/1022 h) of the study period; however, this decreased to 70.3{\%} when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine (P = 0.02) and lorazepam (P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia. Conclusions Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.",
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Arenas-Lopez, S, Riphagen, S, Tibby, SM, Durward, A, Tomlin, S, Davies, G & Murdoch, IA 2004, 'Use of oral clonidine for sedation in ventilated paediatric intensive care patients', Intensive care medicine, vol. 30, no. 8, pp. 1625-1629.

Use of oral clonidine for sedation in ventilated paediatric intensive care patients. / Arenas-Lopez, Sara; Riphagen, Shelley; Tibby, Shane M.; Durward, Andrew; Tomlin, Steve; Davies, Graham; Murdoch, Ian A.

In: Intensive care medicine, Vol. 30, No. 8, 08.2004, p. 1625-1629.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Use of oral clonidine for sedation in ventilated paediatric intensive care patients

AU - Arenas-Lopez, Sara

AU - Riphagen, Shelley

AU - Tibby, Shane M.

AU - Durward, Andrew

AU - Tomlin, Steve

AU - Davies, Graham

AU - Murdoch, Ian A.

PY - 2004/8

Y1 - 2004/8

N2 - Objectives We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design Prospective, cohort study over a 72-h period. Setting Regional paediatric intensive care unit. Patients and participants Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation). Measurements and results Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3–5 mgrg/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95% confidence interval 1.0–1.8). Adequate sedation was achieved during 82% (837/1022 h) of the study period; however, this decreased to 70.3% when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine (P = 0.02) and lorazepam (P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia. Conclusions Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.

AB - Objectives We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design Prospective, cohort study over a 72-h period. Setting Regional paediatric intensive care unit. Patients and participants Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation). Measurements and results Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3–5 mgrg/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95% confidence interval 1.0–1.8). Adequate sedation was achieved during 82% (837/1022 h) of the study period; however, this decreased to 70.3% when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine (P = 0.02) and lorazepam (P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia. Conclusions Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.

KW - Clonidine

KW - Sedation

KW - Paediatric

KW - Intensive care

M3 - Article

VL - 30

SP - 1625

EP - 1629

JO - Intensive care medicine

JF - Intensive care medicine

SN - 0342-4642

IS - 8

ER -

Arenas-Lopez S, Riphagen S, Tibby SM, Durward A, Tomlin S, Davies G et al. Use of oral clonidine for sedation in ventilated paediatric intensive care patients. Intensive care medicine. 2004 Aug;30(8):1625-1629.