Clonidine: Applications in the pediatric neurosurgical patient

Clonidine's antihypertensive effects result ham the activation of central a lpha(2)-adrenergic receptors. This results in a de crease in sympathetic or vasomotor tone from the medulla and a decrease in heart rate and systemic vascular resistance. Despite reports of its use in the pediatric population as a premedicant for the operating room, as an adjunct to caudal epidural anesthesia, to supplement opioid analgesia, and to treat behavioral disorde rs, there is Limited experience with its use as an antihypertensive agent i n children. The author describes his experience with clonidine to control m ean arterial pressure in three pediatric neurosurgical patients when other options for oral therapy including angiotensin converting enzyme (ACE) inhi bitors, beta-adrenergic antagonists, and calcium channel antagonists proved to be ineffective. Previous experience with clonidine as an antihypertensi ve agent in children is reviewed and recommendations made concerning possib le dosing regimens.