Use of Chloral Hydrate For Sedation in Children

Abstract

Publicity about the possible carcinogenicity of chloral hydrate along with the suggestion that alternative sedatives should be used in children has generated concern among physicians, dentists, and their patients.1,2 Replacement of chloral hydrate with other sedatives would represent a major change in practice because it is one of the drugs most widely employed to sedate young children undergoing dental and medical procedures and imaging studies. This statement will assist the practitioner in making an informed decision regarding the use of chloral hydrate by summarizing (1) information pertaining to the potential for carcinogenesis associated with use of chloral hydrate, (2) the risk/benefit considerations of available sedatives, and (3) risks associated with prolonged sedation with chloral hydrate. EVIDENCE FOR CARCINOGENESIS OF CHLORAL HYDRATE Some of the concern regarding potential carcinogenicity of chloral hydrate is based on the assumption that chloral hydrate is a reactive metabolite of trichloroethylene, an industrial solvent, and is responsible for the carcinogenicity of trichloroethylene.1,2 However, the validity of this assumption is open to question. Although chloral hydrate is a metabolite of trichloroethylene, there is evidence that the carcinogenicity of trichloroethylene is due to a reactive intermediate epoxide metabolite rather than chloral hydrate.3 As is the case for most chemical carcinogens, trichloroethylene is carcinogenic in some laboratory animal species but not in others.4 Multiple epidemiologic studies in humans have failed to document an increase in cancer incidence associated with trichloroethylene exposure,5-10 although the ability of these studies to detect small increases in risk of cancer is limited. There are no studies pertaining to chloral hydrate-associated carcinogenicity in humans.