Intravenous clonidine infusion in infants after cardiovascular surgery

Summary Background: The aim of this study was to investigate the hemo-dynamic profile and heart rhythm in infants who were givenintravenous clonidine infusion after prolonged analgesia⁄sedationfollowing cardiac surgery.Methods: This is a single center retrospective review. A total of 542cardiovascular surgical procedures in infants aged 0–24 months withcongenital heart disease were performed between 01⁄2003 and12⁄2005 at the Deutsches Herzzentrum in Berlin. The majorityreceived no long-term analgesia⁄sedation, but 50 (9%) of these infantsreceived clonidine (dosed at 0.18–3.6 lgAEkg )1 AEh )1 ) for sedation and toreduce withdrawal symptoms such as CNS hyperactivation, hyper-tension, tachycardia, and fever. The hospital records of these infantswere studied.Results: Fifty infants (median age 5.0 months, median body weight5.3 kg, 32 males⁄18 females) received prolonged analgesia⁄sedation toensure hemodynamic stability. Clonidine infusion started on day 5(median) after surgery. During clonidine treatment we found an age-related normalized profile of hemodynamic parameters with areduction of heart rate and mean arterial pressure from the uppernorm to the mean within 24 h (P < 0.001). In no case did clonidinecause low blood pressure resulting in additional therapy to reach thetarget blood pressure. There were no adverse effects on cardiacrhythm, especially no onset of atrioventricular block. Midazolam,fentanyl, and other opioids could be ended on day 4 of clonidinetreatment.Conclusions: Although off-label, it is feasible to use clonidine infusionsin infants in the PICU setting after cardiac surgery without hemo-dynamic problems arising.Keywords: cardiovascular surgery; clonidine; infants; withdrawal