American Journal of Ophthalmology, August 2018
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.