Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

Márcia Cristina Pires Nogueira,Gustavo Falbo Wandalsen,Dirceu Solé,Fernanda de Cordoba Lanza

doi:10.1016/j.rppede.2016.06.001

Abstract

ObjectiveTo describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. MethodsAll sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. ResultsThe sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14–182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. ConclusionsThe data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

Highlights

Chloral hydrate (CH) is a hypnotic sedative drug widely used in recent decades to sedate children
CH-induced sedation is considered of moderate intensity and, it is recommended that it be performed under the supervision of physicians and health professionals trained in life support, with available resuscitation equipment and infant monitoring
It is known that the CH can reduce upper airway muscle tone and increase the chance of collapse in infants with some degree of upper airway obstruction, such as those with pharyngeal and palatine tonsil hypertrophy, obstructive sleep apnea and craniofacial abnormalities.[1]

Summary

Introduction

Chloral hydrate (CH) is a hypnotic sedative drug widely used in recent decades to sedate children. CH is the sedative of choice for pulmonary function tests in infants and has been used in several laboratories for more than 25 years.[1,3] It is the drug of choice due to several factors. It is administered orally, does not require venipuncture and induces adequate sedation degree and duration for pulmonary function assessment procedures to be carried out.[1] the available reference equations for pulmonary function parameters were obtained after sedation with CH and use of other sedatives could hinder comparisons and induce biases.[3] In a recent survey carried out at 148 pulmonary function laboratories in infants worldwide, 79% of them used CH as a sedative for exams.[4]

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Conclusion