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Journal of Current Pediatric Research | Volume: 23
March 14-15, 2019 | London, UK
International Conference on
Pediatrics & Neonatal Healthcare
Curr Pediatr Res, Volume 23
DOI: 10.4066/0971-9032-C1-012
C
lonidine and dexmedetomidine are highly selective
alpha-2-agonists of the imidazole subclass. Clonidine
which has been licensed since 1966 is 200 times more
specific for alpha 2 receptors compared to alpha 1 receptors.
It is most commonly known as antihypertensive drug, but its
use has been extended to several off label applications over
the years. Dexmedetomidine is a more recently approved
drug with a specificity of 1600: 1 for alpha-2 receptors which
makes it nearly a complete alpha-2 agonist. Both drugs
bind to peripheral and central sites in the nervous system.
Sedative and anxiolytic effects result from activation of
alpha-2-receptors in the locus coeruleus of the brainstem,
while analgesia is exerted through activation of alpha-2-
agonists in the dorsal horn of the spinal cord.
Sedation produced by alpha-2 agonists resembles natural
sleep with an EEG pattern similar to non-REM sleep. The
key advantage of clonidine and dexmedetomidine is their
ability to maintain respiratory drive. Cardiovascular effects
are characterized by a mild decrease in heart rate and blood
pressure. Furthermore alpha-2 agonists have been shown
to be devoid of neurotoxic effects on the developing brain
in animals and show beneficial effects when administered
alongside with general anaesthetics. All these qualities make
alpha-2 agonists nearly ideal sedatives for children and an
interesting alternative to commonly used benzodiazepines.
Numerous studies prove the effectiveness and safety of
alpha-2-agonists in children. Current clinical applications are
premedication in paediatric anaesthesia, sedation for non-
invasive and invasive procedures, prevention and treatment
of emergence delirium, analgesia, as an adjunct to general
anaesthesia, sedation in the intensive care unit as well as
treatment of withdrawal syndrome and delirium.
e:
n.almenrader@gmail.comAlpha-2-agonists for sedation in children
Nicole Almenrader
Policlinico Umberto I, Viale del Policlinico, Italy