BACKGROUND: Sevoflurane is commonly used as an inhalational induction agent in 
paediatric patients. Emergence agitation is a common post-operative problem in 
young children who have received sevoflurane. Clonidine has proven to be 
effective in reducing the incidence of post-operative agitation at a higher dose 
(3 and 2 μg kg⁻¹). It has some dose-dependent disadvantages, prominently 
bradycardia, hypotension and respiratory impairment.
OBJECTIVE: The authors conducted a study to evaluate the effectiveness of 
low-dose caudal clonidine (1 μg kg⁻¹) in reducing the incidence of 
sevoflurane-induced agitation in preschool children undergoing urogenital and 
lower limb surgery.
METHODOLOGY: A double-blind study was conducted comparing 0.25% (0.75 ml kg⁻¹) 
bupivacaine and clonidine 1 μg kg⁻¹ (group 1), 0.25% bupivacaine (0.75 ml kg⁻¹) 
and clonidine 0.75 μg kg⁻¹ (group 2), with 0.25% bupivacaine (0.75 ml kg⁻¹) 
alone (group 3). Ninety children of 1-5 years of American Society of 
Anesthesiologists I and II were randomly assigned into three groups. 
Post-operatively, patients were monitored for 1 h to observe emergence 
agitation, which was assessed with the help of Pain and Discomfort Scale.
RESULT: Post-anaesthetic agitation was observed in two patients (6.6%) in group 
1, eight patients (26.6%) in group 2 as compared to 12 patients (40%) in group 3 
after 15 min of post-operative observation. The mean scores in group 1 at 15 and 
30 min were significantly lower than those in group 3 (P value <0.05). None of 
the groups had showed any haemodynamic and respiratory compromise, either 
clinically and statistically.
CONCLUSION: Caudal clonidine at a lower dose (1 μg kg⁻¹) could be effective in 
reducing the incidence of sevoflurane-induced emergence agitation in children 
undergoing urogenital and lower limb surgery without any significant adverse 
effects.