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  • Chloral Hydrate Sedation in Children Is Safe and Effective

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, August 2018

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    Cooperation of young children is a concern when diagnostic or therapeu­tic procedures are required. Karaoui et al. assessed the safety and efficacy of chloral hydrate (CH) in facilitating ophthalmic procedures in pediatric outpatients. Overall, the sedative-hypnotic was effective and safe when administered by a dedicated sedation service according to strict protocols.

    This prospective interventional study was conducted at an eye care hospital in Saudi Arabia and included 324 children aged 1 month to 5 years (mean, 2.2 years); mean weight was 10.9 kg. Before undergoing ocular imaging or evaluation, the patients received CH administered by a dedicat­ed sedation service. Documented data included the dosage, level of sedation, vital signs, and adverse events. The primary outcome was the percentage of patients with a sedation level ≥4 within 45 minutes of receiving CH. Secondary outcomes were adverse events and the time until discharge.

    For 306 patients (94.4%), adequate sedation was achieved with a mean initial CH dose of 77.4 mg/kg (standard de­viation [SD], 14.7 mg/kg). Nine others (1.9%) received a second dose (50% of the initial dose); of these patients, 6 obtained adequate sedation. Patients who needed the second dose tended to be older and heavier. Overall, 312 patients (96.3%) had adequate sedation from either 1 or 2 doses. From the time just before CH administration to 25 min­utes after sedation, mean reductions in oxygen (O2) saturation, heart rate, and respiratory rate were 0.81% (SD, 1.2%), 11.7 (SD, 14.3) beats/minute, and 1.2 (SD, 2.4) breaths/minute, respectively.

    The odds of sedation continuing un­til 45 minutes after CH administration were 2.53 times higher for American Society of Anesthesiologists (ASA) class II or III patients than for class I patients, 1.03 times higher per milligram increase in the initial sedation dose, and 2.70 times higher per unit increase in the number of planned procedures. Adverse events were minor and occurred in only 3 patients (O2 de­saturation occurred in 2, and 1 patient experienced paradoxical reaction). The median time from sedation administra­tion to discharge was 90 minutes.

    All planned procedures were com­pleted in 300 children (92.9%). Of the remaining 24, 6 did not achieve ade­quate sedation to begin the procedure, and 15 did not maintain adequate sedation to allow completion of the procedure. (Data are missing on procedure completion for 3 children.) After sedation, all patients could move their extremities, breathe deeply, and cough freely.

    The original article can be found here.