Chloral Hydrate Sedation Research Articles

Chloral hydrate enteral infusion for sedation in ventilated children: the CHOSEN pilot study

BackgroundWe aimed to test a novel method of delivery of chloral hydrate (CH) sedation in ventilated critically ill young children.MethodsChildren < 12 years old, within 72 hours of admission, who were ventilated, receiving enteral tube-feeds, with intermittent CH ordered were enrolled after signed consent. Patients received a CH loading-dose of 10 mg/kg enterally, then a syringe-pump enteral infusion at 5 mg/kg/hour, increasing to a maximum of 9 mg/kg/hour. Cases were compared to historical controls matched for age group and Pediatric Risk of Mortality score (PRISM) category, using Fisher’s exact test and the t test. The primary outcome was feasibility, defined as the use of an enteral CH continuous infusion without discontinuation attributable to a pre-specified potential harm.ResultsThere were 21 patients enrolled, at age 11.4 (12.1) months, with bronchiolitis in 10 (48%), a mean Pediatric Logistic Organ Dysfunction (PELOD) score of 6.2 (5.2), and having received enteral CH continuous infusion for 4.5 (2.2) days. Infusion of CH was feasible in 20/21 (95%; 95% CI 76–99%) patients, with one (5%) adverse event of duodenal ulcer perforation on day 3 in a patient with croup receiving regular ibuprofen and dexamethasone. The CH infusion dose (mg/kg/h) on day 2 (n = 20) was 8.9 (IQR 5.9, 9), and on day 4 (n = 11) was 8.8 (IQR 7, 9). Days to titration of adequate sedation (defined as ≤ 3 PRN doses/shift) was 1 (IQR 0.5, 2.5), and hours to awakening for extubation was 5 (IQR 2, 9). Cases (versus controls) had less positive fluid balance at 48 h (-2 (45) vs. 26 (46) ml/kg, p = 0.051), and a decrease in number of PRN sedation doses from 12 h pre to 12 hours post starting CH (4.7 (3.3) to 2.6 (2.8), p = 0.009 versus 2.9 (3.9) to 3.4 (5), p = 0.74). There were no statistically significant differences between cases and controls in inotrope scores, signs or treatment of withdrawal, or PICU days.ConclusionsDelivering CH by continuous enteral infusion is feasible, effective, and may be associated with less positive fluid balance. Whether there is a risk of duodenal perforation requires further study.

Predictive value of N95 waveforms of pattern electroretinograms (PERGs) in children with optic nerve hypoplasia (ONH).

As part of a long-term, prospective study of prenatal and clinical risk factors for optic nerve hypoplasia (ONH) at Children's Hospital Los Angeles, pattern ERGs (PERGs) were evaluated for prognostic value using an automated objective and robust analytical method. Participants were 33 children with ophthalmoscopically diagnosed ONH [disc diameter-to-disc macula ratio (DD/DM) less than 0.35 in one or both eyes on fundus photographs]. Using cycloplegia and chloral hydrate sedation in one session before 26months of age, we recorded PERGs to checkerboard reversal using five check sizes. Participants were followed with clinical and psychometric testing until 5years of age. PERGs were analysed using automated robust statistics based on magnitude-squared coherence and bootstrapping optimized to objectively quantify PERG recovery in the challenging recordings encountered in young patients. PERG measures in the fixating or better-seeing eyes were compared with visual outcome data. PERG recording was complete to at least three check sizes in all eyes and to all five sizes in 79%. Probability of recording a PERG that is significantly different from noise varied with check size from 73% for the largest checks to 30% for the smallest checks (p=0.002); smaller waveforms were associated with earlier implicit times. The presence of significant PERGs in infancy is associated with better visual outcomes; the strongest association with visual outcome was for the threshold check size with a significant N95 component (ρ=0.398, p=0.02). Automated statistically robust signal-processing techniques reliably and objectively detect PERGs in young children with ONH and show that congenital deficits of retinal ganglion cells are associated with diminished or non-detectable PERGs. The later negativity, N95, was the best indicator of visual prognosis and was most useful to identify those with good visual outcomes (≤0.4 LogMAR). Although PERGs reflect function of the inner layers of the central retina, they lack the specificity required to determine prognosis reliably in individual cases.

Safety and Efficacy of Chloral Hydrate Sedation in Paediatric Sedation for Ophthalmic Procedures

Chloral hydrate (CH) sedation is routinely used in paediatric ophthalmic examination in Singapore as an alternative to examination under general anaesthesia. Despite CH's traditionally high success rates and relatively low rate of adverse events, there is little data on its safety and efficacy as a sedative for ophthalmic procedures in an Asian population. A retrospective chart review was performed, including children who underwent CH sedation at the Singapore National Eye Centre from January 2012 to January 2015. Participants were given an initial dose of CH and a top-up dose if required. Univariate and multivariate analyses were performed on data collected. CH sedation was successful in 144 of 153 children (94.1%). Of the 20 (13.0%) who required a top-up dose, 4 failed to sedate. The mean sedation onset was 29.4 minutes (SD: 24.3) and mean sedation duration was 56.5 minutes (SD: 24.0), with more than a third lasting more than 1 hour. The age of children, rather than initial dose of CH, was more relevant in determining success of sedation. Children who were >6 years old were 20.3 times more likely to fail sedation than those aged <2 years. During sedation, depression in the heart rate and a transient reduction of oxygen saturation was documented. All children recovered well post-sedation. CH is a very useful sedative for paediatric ophthalmic procedures, especially in younger children. Children over 4 years old were more likely to fail sedation and require top-up doses. Alternative means of sedation may need to be considered in these cases.

Median Effective Dose of Intranasal Dexmedetomidine for Rescue Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging

The median effective dose (ED50) of intranasal dexmedetomidine after failed chloral hydrate sedation has not been described for children. This study aims to determine the ED50 of intranasal dexmedetomidine for rescue sedation in children aged 1 to 36 months, who were inadequately sedated by chloral hydrate administration during magnetic resonance imaging (MRI). This study was performed on 120 children, who were 1 to 36 months old and underwent MRI scanning. Intranasal dexmedetomidine was administered as a rescue sedative to children not adequately sedated after the initial oral dose of chloral hydrate (50 mg/kg). Children were stratified into four age groups. ED50 values were estimated from the up-and-down method of Dixon and Massey and probit regression. Other variables included induction time, time to wake up, vital signs, oxygen saturation, MRI scanning time, and recovery characteristics. ED50 of intranasal dexmedetomidine for rescue sedation was 0.4 μg/kg (95% CI, 0.34 to 0.50) in children aged 1 to 6 months, 0.5 μg/kg (95% CI, 0.48 to 0.56) in children aged 7 to 12 months, 0.9 μg/kg (95% CI, 0.83 to 0.89) in children aged 13 to 24 months, and 1.0 μg/kg (95% CI, 0.94 to 1.07) in children aged 25 to 36 months. There were no significant differences in sedation induction time or time to wake up between the different age groups. Additionally, no significant adverse hemodynamic or hypoxemic effects were noted. The authors determined the ED50 for rescue sedation using intranasal dexmedetomidine after failed chloral hydrate sedation in children. It was found that ED50 increases with advancing age during the first 3 yr of life.

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

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.

Eficácia e segurança do hidrato de cloral na sedação de lactentes para testes de função pulmonar

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 to 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.

Retrospective Comparison of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response Exams.

Satisfactory conditions for auditory brainstem responses (ABR) screening tests for pediatric hearing loss are usually achieved with oral chloral hydrate (CH) sedation. When the US manufacture of this drug was discontinued for business reasons, we developed an alternative sedation regimen using intranasal dexmedetomidine (IN DEX) 4 μg/kg. This institutional review board-approved retrospective study compared the efficacy and adverse effect profiles of these 2 sedative regimens. Medical records of children receiving oral CH or IN DEX for ABR were surveyed for demographic data and times from sedative administration to start and completion of the ABR procedure and recovery times. We also noted if the examination was completed with or without interruptions, failed for inadequate sedation, and if predefined cardiorespiratory adverse events occurred. In the IN DEX cohort, the examination could be completed more frequently with a single dose of medication (P = .002). Satisfactory sedation in these patients permitted an earlier start of both the ABR examination and recovery to the awake status (P < .001 and < .045, respectively). Hypoxia requiring oxygen therapy was more frequent in the CH group. This retrospective study found that IN DEX provides effective sedation for ABR examinations, with the benefits of an ability to begin the test sooner and complete the examination with a single dose, in addition to a decreased incidence of hypoxemia. A randomized controlled trial should test the hypothesis that the IN DEX technique is superior to the well-established standard oral CH regimen.

The Use of Patient Registries to Detect Risk Factors of Anesthesia and Sedation Complications.

* Abbreviation: PSRC — : Pediatric Sedation Research Consortium Beginning in the 1980s, prospective studies confirmed what was previously suspected from case reports: that prematurely born infants were at a higher risk of developing central and obstructive apneas after general anesthesia compared with their term counterparts.1,2 This finding resulted in the extended use of cardiorespiratory monitoring (ie, usually overnight) in these infants after exposure to anesthetic agents before discharge from the hospital. Although a number of centers reported varying results, this increased risk seemed to last until ∼5 or 6 months into the first year of life. Similarly, an increased risk of postprocedure oxyhemoglobin desaturation was found in preterm infants after chloral hydrate sedation for MRIs.3 Although most pediatric anesthesiologists would agree that prematurity is a strong risk factor for additional respiratory complications (eg, bronchospasm, laryngospasm), surprisingly little information has been published on the subject. With this in mind, the Pediatric Sedation Research Consortium (PSRC) was created and, in this issue of Pediatrics , Havidich et al4 report their analysis of sedation- and anesthesia-related adverse events across a wider range … Address correspondence to Ronald S. Litman, DO, Department of Anesthesiology, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104. E-mail: litmanr{at}email.chop.edu

Chloral hydrate sedation for auditory brainstem response (ABR) testing in children: Safety and effectiveness

IntroductionThe auditory brainstem response (ABR) test is used to identify hearing loss and measure hearing thresholds of infants and children who cannot be tested using standard behavioral hearing testing methods. In order for the ABR to yield useful data, a child must be asleep throughout the duration of the test. In many centers, this is achieved through the use of a general anesthetic, with its inherent risks and costs. Since 2004, ABRs have been routinely conducted at BC Children's Hospital in an ambulatory care setting under oral chloral hydrate sedation, with monitoring by a specialist nurse. The aim of this retrospective study was to assess the effectiveness and safety of nurse-led sedation with chloral hydrate for ABR testing at our tertiary pediatric center. MethodsMedical and audiology records were reviewed for children aged 6 months to 17 years who underwent ABR testing from 2004 to 2012. We reviewed the dosage of drug used, condition of the child after chloral hydrate administration, adverse effects, audiological results, patients’ vital signs, and the effectiveness of the sedative in keeping the child asleep throughout the duration of the test. Frequency distributions were derived for adverse outcomes. Results725 ABR records encompassing 635 children (multiple ABR tests in some children) were reviewed. The average dose of chloral hydrate used was 52mg/kg. The majority of sedated ABR's (80.8%) were completed without any incident. Significant events [apnea and/or bradycardia], minor complications [vomiting, hypoxemia, prolonged sedation, and/or tachypnea] and restlessness were noted in 3.4%, 6.2%, and 5.0% of the cases, respectively. The majority of these issues resolved without medical intervention, such as the need to provide supplementary oxygen. In 95.9% of ABRs, chloral hydrate was successful in sedating the child adequately to answer the audiological question. ConclusionsThis forms the largest study to date on oral sedation for ABR testing. Based on our results, the use of chloral hydrate in the presence of a sedation nurse was a safe and reliable method of performing ABR in infants and children. This may be of significant value to centres worldwide exploring alternatives to general anesthesia for ABR testing.

A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing.

Dexmedetomidine is increasingly used by various routes for pediatric sedation. However, there are few randomized controlled trials comparing the efficacy of dexmedetomidine to other commonly used sedatives. To compare the efficacy of sedation with intranasal dexmedetomidine to oral chloral hydrate for auditory brainstem response (ABR) testing. In this double-blind, double-dummy study, children undergoing ABR testing were randomized to receive intranasal dexmedetomidine 3 mcg · kg(-1) plus oral placebo (Group IN DEX) or oral chloral hydrate 50 mg · kg(-1) plus intranasal saline placebo (Group CH). We recorded demographic data, times from sedative administration to start and completion of testing, quality of sedation, occurrence of predefined adverse events, discharge times, and return to baseline activity on the day of testing. Testing completion rates with a single dose of medication were higher in the IN DEX group (89% vs 66% for CH, odds ratio with 95% confidence intervals 4.04 [1.3-12.6], P = 0.018). The median [95% CI)] time to successful testing start was shorter (25 [20-29] min vs 30 [20-49] min for IN DEX and CH, respectively, log rank test P = 0.02) and the proportion of children whose parents reported a return to baseline activity on the day of testing was greater for the IN DEX than the CH group (89% vs 64%, OR [95% CI] 4.71 [1.34-16.6], P = 0.02). There were no major adverse events in either group and no significant differences in the incidence of minor events. Intranasal dexmedetomidine is an effective alternative to oral chloral hydrate sedation for ABR testing, with the advantages of a higher incidence of testing completion with a single dose, shorter time to desired sedation level, and with significantly more patients reported to return to baseline activity on the same day.

A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

Purpose:To compare intraocular pressure (IOP) measurements by rebound tonometry (Icare PRO; Icare Finland Oy, Helsinki, Finland) to measurements by indentation tonometry (Pneumotonometer Model 30 classic and Tono-Pen XL; Reichert, Buffalo, NY, USA) in supine sedated children with glaucoma.Methods:Prospective comparative observational study of Saudi Arabian children with glaucoma undergoing chloral hydrate sedation for ophthalmic examination (February 2012 - February 2013). Nonglaucomatous eyes were included as controls. Eyes with corneal scars or prior corneal transplant or lamellar surgery were excluded.Results:Fifty-two eyes (26 OD, 26 OS) of 28 children were included. Thirty-six eyes had glaucoma (32 primary congenital glaucoma, two Sturge-Weber related, and two aphakia related). Sixteen eyes did not have glaucoma (six with pediatric cataract, five normal eyes, two strabismic eyes, two eyes with simple megalocornea, and one eye had peripheral corneal laceration repair. In the glaucoma group, the mean IOP was 17.55 ± 5.97 mmHg (range, 8-31.5 mmHg) with the Icare PRO and 20 ± 6.4 mmHg (range, 8-35.5 mmHg) with the Pneumotonometer from 20.47 ± 6.81 mmHg (range, 10-43 mmHg) with the Tono-Pen XL. The Icare PRO readings were significantly lower than each of the indentation tonometers. For the control group, there was no statistically significant difference in IOP measured by the Icare PRO and the indentation tonometers.Conclusions:In this population of supine sedated children with glaucoma, IOP measurements with the Icare PRO tend to be lower than readings from the Pneumotonometer and Tono-Pen XL.

Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures

Background/aimsThe inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out...

G568(P) Sedation for mri/cy: a service improvement project

Context The information for this project was collected from the children’s wards at UHCW. Patients attending for elective scans requiring sedation were included. Sedation was administered as per the trust protocol. This protocol is based on current NICE and BNFc guidance. Weight Weight >15 kg - Midazolam sedation Problem We found that sedation of children for elective MRI/CT scans was insufficient more often than not. This led to failed scans which in turn led to delays in diagnosis, stress for patients and families. In addition this incurred significant financial cost to the Trust due to failed scans and referrals to BCH for scans under GA. Assessment of problem and analysis of its causes 60 scans were reviewed over a 6 month period in 2013. 38 children underwent midazolam sedation and 22 were given chloral hydrate. Chloral hydrate sedation was successful in 90% of cases, whereas midazolam was only successful in 18% of cases. After discussion with the finance department we calculated that failed scans combined with referrals to BCH was costing the trust c. £70,000 per year. Intervention We have discontinued the use of midazolam sedation for MRI/CT scans The trust is in the process of developing a paediatric GA scan service at UHCW Strategy for change The initial results of the study were presented to the paediatric department at the monthly clinical audit meeting. After discussion, the decision to stop using midazolam for scan sedation was disseminated amongst community and hospital based paediatricians. A multi-disciplinary team comprising paediatricians, radiographers, radiologists and anaesthetists was formed. This team is in the process of designing and trialling a GA scan service at UHCW. This will enable us to provide scans to children who would beforehand have probably had 1–2 failed scans and then been referred to BCH. In addition this service may also provide the trust with increased revenue and savings. Measurement of improvement We now only have children weighing 15 kgs that require sedation are being referred directly to BCH for GA scans while we develop our own service. This ensures that they will not need to undergo a probably unsuccessful scan under sedation with us before being referred. Effects of changes Discontinuing the use of midazolam sedation has prevented children undergoing a stressful procedure that was unsuccesful in 82% of cases. This has improved patient care in the form of reducing delays in diagnosis and lowering parental anxiety. It has also saved the trust c. £70,000 per year in failed scans and referrals to BCH. Lessons learnt This project has shown me that using a structured approach when considering a problem makes it easier to change systems/processes. Our department knew that midazolam wasn’t particularly successful but when you present that as a 82% failure rate it makes things a lot clearer. Forming an MDT to try to find a solution was also of huge benefit as it very quickly became clear that the radiology department shared our frustrations regarding failure of sedation. This in turn has enabled us to move forward with development of our own GA scan service quite quickly. Message for others If you feel there is a problem/issue in your department analyse it in a structured way and try to form a solution to the issue rather just presenting a problem If an MDT needs to be involved ensuring that there are clear goals identified is very important so as to avoid being sidetracked.

Functional magnetic resonance imaging can be used to explore tactile and nociceptive processing in the infant brain.

AimDespite the importance of neonatal skin stimulation, little is known about activation of the newborn human infant brain by sensory stimulation of the skin. We carried out functional magnetic resonance imaging (fMRI) to assess the feasibility of measuring brain activation to a range of mechanical stimuli applied to the skin of neonatal infants.MethodsWe studied 19 term infants with a mean age of 13 days. Brain activation was measured in response to brushing, von Frey hair (vFh) punctate stimulation and, in one case, nontissue damaging pinprick stimulation of the plantar surface of the foot. Initial whole brain analysis was followed by region of interest analysis of specific brain areas.ResultsDistinct patterns of functional brain activation were evoked by brush and vFh punctate stimulation, which were reduced, but still present, under chloral hydrate sedation. Brain activation increased with increasing stimulus intensity. The feasibility of using pinprick stimulation in fMRI studies was established in one unsedated healthy full-term infant.ConclusionDistinct brain activity patterns can be measured in response to different modalities and intensities of skin sensory stimulation in term infants. This indicates the potential for fMRI studies in exploring tactile and nociceptive processing in the infant brain.

The Safety and Efficacy of Chloral Hydrate Sedation for Pediatric Ophthalmic Procedures: A Retrospective Review

To determine the safety and efficacy of high-dose oral chloral hydrate for pediatric ophthalmic procedures. This study is a retrospective review of a quality audit of pediatric sedation for ophthalmic evaluation and imaging performed at King Khaled Eye Specialist Hospital between January 1 and December 31, 2011, in children aged 1 month to 6 years. Three hundred fifty-eight of 380 (94.2%) sedation procedures were successful after a single dose of chloral hydrate, with 356 of 380 (93.7%) children sedated within 45 minutes of the first dose. The total success rate of the sedation procedure increased to 97.9% (372 of 380) when a second dose was administered. Children adequately sedated after a single dose of chloral hydrate were on average younger and weighed less than children who required additional doses. No major adverse events were documented. The use of chloral hydrate sedation for ophthalmic evaluation and imaging was safe and effective in this patient population with a high rate of procedure completion.

Chloral hydrate sedation for infant pulmonary function testing

Chloral hydrate sedation for infant pulmonary function testing

Pharmacodynamics of oral chloral hydrate sedation for echocardiography in pediatric patients with congenital heart disease

Objective To evaluate the pharmacodynamics of oral chloral hydrate sedation for echocardiography in pediatric patients with congenital heart disease (CHD).Methods Two hundred ASA physical status Ⅱ-Ⅳ pediatric patients with CHD, aged 5-620 days,scheduled for elective echocardiography,were enrolled in the study.The dose of oral chloral hydrate was set at 50 mg/kg in the first pediatric patient.The oral dosage was determined by up-and-down sequential experiment.Each time the oral dose increased/decreased by 10％ in the next pediatric patient.The pharmacodynamics was analyzed based on the dose-response model to determine the 50％ effective dose (ED50),95％ effective dose (ED95) and 95％ confidence interval (95％ CI) of chloral hydrate for sedation.The covariates (age,gender,time period of administration,fasting time,sleeping at 2 h before sedation,premature and cyanotic CHD) were introduced into the dose-response model,and the effect of each covariate on the pharmacodynamics of chloral hydrate sedation was evaluated.Results The ED50 of chloral hydrate for sedation during echocardiography was 42.2 mg/kg (95 ％ CI 40.2-44.2 mg/kg), ED95 was 67.4 mg/kg (95％ CI 53.7-81.1 mg/kg) in the pediatric patients with CHD.Each covariate provided no effect on the pharmacodynamics of chloral hydrate sedation (P ＞ 0.05).When fasting time and premature were introduced into the dose-response model,95％ CI of the slope of dose-response curve included 0.When age which was stratified was introduced into the dose-response model,it was difficult to fit or the data seriously deviated from the clinical data.Conclusion The ED50 and ED95 of chloral hydrate for sedation during echocardiography were 42.2 mg/kg (95％ CI 40.2-44.2 mg/kg) and 67.4 mg/kg (95％CI 53.7-81.1 mg/kg),respectively,in the pediatric patients with CHD.Gender,time period of administration,sleeping before sedation and cyanotic CHD do not affect the pharmacodynamics of oral chloral hydrate sedation,while the effect of age,fasting time and premature needs further determination. Key words: Chloral hydrate; Heart defects, congenital; Conscious sedation; Echocardiography,Doppler, color; Dose-response relationship, drug; Child

Intranasal dexmedetomidine following failed chloral hydrate sedation in children

Chloral hydrate is the most commonly used sedative for paediatric diagnostic procedures in China with a success rate of around 80%. Intranasal dexmedetomidine is used for rescue sedation in our centre. This prospective investigation evaluated 213 children aged onemonth to 10years who were not adequately sedated following administration of chloral hydrate. Children were randomly assigned to receive rescue intranasal dexmedetomidine at 1μg.kg(-1) (group 1), 1.5μg.kg(-1) (group 2) or 2μg.kg(-1) (group 3). The sedation level was assessed every 10min using a modified observer's assessment of alertness/sedation scale. Successful rescue sedation in groups 1, 2 and 3 were 56 (83.6%), 66 (89.2%) and 51 (96.2%), respectively. Increasing the rescue dose was associated with an increased success rate with an odds ratio of 4.12 (95% CI 1.13-14.98), p=0.032. We conclude that intranasal dexmedetomidine is effective for sedation in children who do not respond to chloral hydrate.

Chloral Hydrate Sedation in Children

Chloral Hydrate Sedation in Children

Chloral hydrate sedation for magnetic resonance imaging in newborn infants.

The aim of this study was to look for clinically significant adverse effects of chloral hydrate used in a large cohort of infants sedated for magnetic resonance imaging. Case notes of infants who underwent magnetic resonance imaging (MRI) scanning from 2008 to 2010 were reviewed, with patient demographics, sedation dose, comorbidities, time to discharge, and side effects of sedation noted. Four hundred and eleven infants (median [range] postmenstrual age per weight at scan 42 [31(+4) -60] weeks per 3500 g [1060-9900 g]) were sedated with chloral hydrate (median [range] dose 50 [20-80] mg·kg(-1)). In three cases (0.7%), desaturations occurred which prompted termination of the scan. One infant (0.2%) was admitted for additional observation following sedation but had no prolonged effects. In 17 (3.1%) cases, infants had desaturations which were self-limiting or responded to additional inspired oxygen such that scanning was allowed to continue. When adhering to strict protocols, MRI scanning in newborn infants in this cohort was performed using chloral hydrate sedation with a relatively low risk of significant adverse effects.