Clonidine
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Flaccidity, prolonged sedation and respiratory insufficiency following intrathecal administration in an infant: case report A 3.5-month-old male infant developed prolonged sedation, flaccidity and respiratory insufficiency after receiving intrathecal clonidine for spinal anaesthesia. The infant presented for a bilateral inguinal hernia repair and received propofol for sedation. A lumbar puncture was performed and he received 0.53mL of intrathecal clonidine 5µg and bupivacaine. After 5 minutes, the height of spinal block was T3. Within 8 minutes, he was deeply sedated. Propofol was discontinued, but the infant continued to be deeply sedated and lethargic. He was flaccid and had no spontaneous movement of his upper limbs. He had inadequate respiratory efforts along with apnoea. He received thiopental sodium and tracheal intubation was performed. Anaesthesia was maintained with sevoflurane and nitrous oxide. The surgery lasted for 62 minutes, after which the inhalation agents were discontinued. He was transferred to a postanaesthesia unit and mechanical ventilation was continued. The movement returned in his upper limbs at 7 hours and 26 minutes after spinal anaesthesia and, 8 hours after the spinal block, his motor function had completely recovered. He was extubated and rescue analgesia was started at 8 hours and 17 minutes. He was observed for 72 hours and did not develop apnoea, desaturation or haemodynamic instability. Author comment: "The flaccidity of limb muscles, prolonged sedation, and respiratory depression suggests the occurrence of CNS toxicity with clonidine . . . due to cephalad spread of clonidine." Rakesh SV, et al. Cephalad migration of intrathecal clonidine in an infant undergoing bilateral herniorrhaphy. Canadian Journal of Anaesthesia 56: 629-630, 801154896 No. 8, Aug 2009 - India
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Reactions 9 Jan 2010 No. 1283
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