Background: One of anesthesia techniques in pediatrics undergoing labioplasty is inhalation of anesthetic sevoflurane. Emergence agitation and delirium (EAD) is a common effect of sevoflurane. Several drugs are used to prevent EAD, such as diphenhydramine and clonidine.

Aim: This study was To compare clonidine and diphenhydramine to reduce post-sevoflurane EAD in pediatric patients undergoing labioplasty.

Methods: This was a double blind randomized controlled trial. A total of 50 pediatric patients, age of 9 months – 2 years old, that underwent labioplasty in two hospitals in Semarang, with ASA I-II status, were enrolled in this study. The subjects underwent general anesthetic sevoflurane and randomized into two groups. Group I received diphenhydramine 0.5 mg/kg, while group II received clonidine 2 μg/kg, both at 15 minutes before turning off the sevoflurane. The EAD was examined with PAED scale at pre-anesthesia, 1 minute post-extubation, at recovery of consciousness, and at 15 minutes post-extubation.

Results: PAED scale in clonidine group was significantly lower than in diphenhydramine group at the time the patients started to recover the consciousness (8.2±0.61 vs 8.9±0.68, p=0.000) and at 15 minutes post-extubation (8.0±0.58 vs 8.5±0.58, p=0.000). There was a lower increase of PAED scale at the recovery of consciousness in clonidine group compared to diphenhydramine group (2.5% vs 11.2%, respectively, p=0.000).

Conclusion: Clonidine was better than diphenhydramine to prevent post-sevoflurane EAD in pediatric patients undergoing labioplasty procedure. These findings may have important implications for the early prevention management of EAD in pediatric patients.

Keywords: sevoflurane, emergence agitation and delirium, PAED scale, clonidine, diphenhydramine