Clonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea

Objective: Regional anesthesia without adjunctive general anesthesia or sed ation has been recommended for preterm infants to decrease the risk of post operative apnea. Single-dose caudal local anesthetic has a limited duration , which may be insufficient for long surgery. Addition of clonidine to loca l anesthetics has been shown to prolong the duration of surgical analgesia. However, respiratory depression related to clonidine may occur in adults. Respiratory depression has not been reported after caudal administration of clonidine in preterm infants. Here we report a case of early postoperative apnea in a waking preterm infant after caudal anesthesia performed with li docaine, bupivacaine, and clonidine. Case Report: A male infant, 39 postconceptual weeks old, was administered a single-injection caudal anesthesia without sedation with 5 mg/kg lidocaine plus 2.5 mg/kg bupivacaine and 1.25 mug/kg clonidine for bilateral inguina l hernia repair, and had early postoperative apneic events. Except for gest ational age, the patient showed no apparent risk factors for postoperative apnea. The infant was monitored 24 hours in a neonatal intensive care unit, and no other apnea was recorded. Conclusions: Our report suggests that clonidine may be responsible for post operative apnea in a preterm neonate. Further studies are required to deter mine the useful safe dose of clonidine for single-injection caudal anesthes ia in those infants.