Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial
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Summary Background Procedural sedation using chloral hydrate is used in many institutions to improve the quality of transthoracic echocardiograms ( TTE ) in infants and young children. Chloral hydrate has limited availability in some countries, creating the need for alternative effective sedatives. Objective The aim of our study was to compare the effectiveness of two doses of intranasal dexmedetomidine vs oral chloral hydrate sedation for transthoracic echocardiography. Methods This is a randomized, prospective study of 150 children under the age of 3 years with known or suspected congenital heart disease scheduled for transthoracic echocardiography with sedation. Group CH received oral chloral hydrate 70 mg·kg −1 , group DEX 2 received 2 μg·kg −1 intranasal dexmedetomidine, and group DEX 3 received 3 μg·kg −1 intranasal dexmedetomidine. Acceptance of drug administration, sedation onset and duration, heart rate, and oxygen saturation, sonographer and parent satisfaction were recorded. Results All patients were successfully sedated for TTE . A second sedative dose (rescue) for failed single‐dose sedation was required for 4% of patients after CH , none of the patients after DEX 2, and 4% of patients after DEX 3. Patients in group CH had an average heart rate decline of 22% during sedation, while group DEX 2 decreased 27%, and group DEX 3 23% ( P = 0.2180). Mean time from administration of the sedative to final patient discharge was 96 min after CH , 83 min after DEX 2, and 94 min after DEX 3 ( P = 0.1826). Conclusion Intranasal dexmedetomidine 2 and 3 μg·kg −1 were found to be as effective for TTE sedation as oral chloral hydrate with similar sedation onset and recovery time and heart rate changes in this study population.Keywords:
Chloral hydrate
Dexmedetomidine
Chloral
This study investigated correlations between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients.With parental consent, 84 children who were placed under moderate or deep sedation with chloral hydrate for examinations from November 19, 2020 to July 9, 2022 were recruited.Patients' average age was 19.9 months. Pediatric neurology patients and those who underwent electroencephalography took significantly longer to achieve sedation with chloral hydrate. There was a negative correlation between the time to achieve sedation and actual sleep time within 24 hours prior to the examination. Positive correlations were found between the actual sleep time 24 hours prior to the examination and the second dose per weight, as well as between the sedation recovery time and awake hours before the examination.Sleep restriction is not an effective adjuvant therapy for chloral hydrate sedation in children, and sedation effects vary according to pediatric patients' characteristics. Therefore, it would be possible to reduce the unnecessary efforts of caregivers who restrict children's sleep for examinations. It is more important to educate parents about safe sedation than about sleep restriction.
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Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied.
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PURPOSE: To compare the effectiveness and safety of oral pentobarbital and oral chloral hydrate for sedation in infants younger than 1 year during magnetic resonance (MR) imaging and computed tomography (CT). MATERIALS AND METHODS: A computerized database was used to collect information about all cases in which sedation was used. Outcomes of all infants who received oral pentobarbital or oral chloral hydrate for sedation between 1997 and 2002 were reviewed. Two study groups were compared for sedation and discharge times by using Student t test and for adverse events by using Fisher exact test and multiple logistic regression analysis. RESULTS: Infants (n = 1,316) received an oral medication for sedation. Mean doses were 50 mg/kg chloral hydrate and 4 mg/kg pentobarbital. Student t test demonstrated no difference in mean time to sedation and in time to discharge between groups. Overall adverse event rate during sedation was lower with pentobarbital (0.5%) than with chloral hydrate (2.7%) (P < .001). There were fewer episodes of oxygen desaturation with pentobarbital (0.2%) than with chloral hydrate (1.6%) (P < .01). Both medications were equally effective in providing successful sedation. CONCLUSION: Although oral pentobarbital and oral chloral hydrate are equally effective, the incidence of adverse events with pentobarbital was significantly reduced. © RSNA, 2003
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Chloral hydrate
Chloral
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Depression
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OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.
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To compare sedation outcomes for chloral hydrate (CH) and midazolam (MD) as sedative agents for diagnostic procedures in children.A prospective, randomized, double-blinded study conducted between July 2005 and October 2006, at the Pediatric Day Care Unit (DCU), King Abdulaziz Medical City, Riyadh, Saudi Arabia. After meeting the inclusion criteria and getting informed consent, patients were randomized, given the study drug, and monitored for sedation outcomes.Two hundred and seventy-five patients who had 292 sedation sessions for diagnostic procedures were included in the study. Due to missing data, 286 sedations were included in the final analysis; 144 in the CH and 142 in the MD group. Both groups were comparable with respect to demographic and baseline characteristics. The CH compared to MD group, had a higher sedation success rate, shorter time to achieve sedation, shorter length of stay in DCU, and longer sedation duration. In both study groups, patients who required a second dose tended to be older and heavier. No major side effects were encountered. The CH group had a significantly higher mean sedation scores at 15, 30, 45, and 60 minutes.Chloral hydrate compared to MD, had a shorter time to achieve sedation, a higher success rate, less need for a second dose, and decreased the time spent in the DCU. Older and heavier patients are more likely to require a second dose of the study drug to be sedated.
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It is annoying for infants to operate examination, because they often cry during examination, which makes it difficult to carry out the examination smoothly. Therefore we aimed to investigate the effect of bundle intervention on chloral hydrate enema sedation in infants. This observational analytic study was a design of a non-randomized controlled trail, we conducted in infants aged from 0 to 3 who were hospitalized in a pediatric hospital. A total of 293 infants from July to December in 2020 were sedated by chloral hydrate enema. According to the admission time, they were divided into a control group (admitted from July to September) and an experimental group (admitted from October to December). The control group received chloral hydrate enema sedation under conventional nursing, while the experimental group was given both the conventional chloral hydrate enema sedation and bundle intervention. The success rate of chloral hydrate enema sedation was compared between the two groups. The success rate of chloral hydrate sedation in the experimental group was 92.50%, significantly higher than that in the control group (74.60%), and there was a significant difference between the two groups (P < 0.05). Therefore, bundle intervention can effectively improve the sedation success rate of chloral hydrate enema in infants and relieve the pain caused by repeated enema, which has great clinical application value.
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Objective To observe the sedative effect of dexmedetomidine on the patients with Cerebral Lesions in ICU.Methods Dexmedetomidine is given by continuous infusion following a load dose to provide satifactory sedation in 50 patients with Cerebral Lesions.Maintain Ramsay score 2 ～ 5 points.Results The sedation efficiency was(86.6 ± 7.3) %.The average infusion rate of midazolam during the sedative period was (0.52 +0.13) μg/(kg·h),while the signs of life remained stable.Conclusion Dexmedetomidine can provide satisfactory sedation and unique advantage for ICU patients.
Dexmedetomidine
Midazolam
Continuous Infusion
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