A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children

Abstract

Chloral hydrate is commonly used to sedate children for painless procedures. Children may recover more quickly after sedation with dexmedetomidine, which has a shorter half-life. We randomly allocated 196 children to chloral hydrate syrup 50 mg.kg and intranasal saline spray, or placebo syrup and intranasal dexmedetomidine spray 3 μg.kg , 30 min before computerised tomography studies. More children resisted or cried after drinking chloral hydrate syrup than placebo syrup, 72 of 107 (67%) vs. 42 of 87 (48%), p = 0.009, but there was no difference after intranasal saline vs. dexmedetomidine, 49 of 107 (46%) vs. 40 of 87 (46%), p = 0.98. Sedation was satisfactory in 81 of 107 (76%) children after chloral hydrate and 64 of 87 (74%) children after dexmedetomidine, p = 0.74. Of the 173 children followed up for at least 4 h after discharge, 38 of 97 (39%) had recovered normal function after chloral hydrate and 32 of 76 (42%) after dexmedetomidine, p = 0.76. Six children vomited after chloral hydrate syrup and placebo spray vs. none after placebo syrup and dexmedetomidine spray, p = 0.03.

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

“…Sevoflurane affects the number of slow delta and alpha waves [18]. The sedative drugs midazolam and chloral hydrate were used in the past; while they exhibited little interference with EEG, they had a long half-life, many side effects, high sedation failure rates and other undesirable characteristics [19,20]. DEX has a good sedative effect when it is administered via intranasal administration or intravenous injection [21].…”

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

“…From our experience, we expect the sedation success rate of intranasal dexmedetomidine alone would be similar to that of the chloral hydrate in non‐painful procedural; hence, we chose to add buccal midazolam to intranasal dexmedetomidine with an aim to evaluate if this regimen would be a better and safe alternative ABR studies.…”

“…17 The incidence of respiratory depression or adverse respiratory events with intranasal dexmedetomidine for procedural sedation was very low. 3,4,7 Although bradycardia and hypotension was more common side effects, intervention was rarely required.…”

“…Oral chloral hydrate is the most commonly used sedative in children for ABR test; intranasal dexmedetomidine is used increasingly for other non‐painful procedural sedation . The successful sedation rate of intranasal dexmedetomidine was similar to oral chloral hydrate for computer tomography studies, but intranasal dexmedetomidine was associated with better behavior and less gastrointestinal side effects . While CT studies are short and non‐stimulating, ABR tests lasts longer and are more stimulating.…”

“…[2][3][4][5][6] The successful sedation rate of intranasal dexmedetomidine was similar to oral chloral hydrate for computer tomography studies, but intranasal dexmedetomidine was associated with better behavior and less gastrointestinal side effects. 7 While CT studies are short and nonstimulating, ABR tests lasts longer and are more stimulating. In our center, a full ABR tests are performed to obtain full profile of latency-intensity function and the intensity used is 90-100 decibels, whereas 60 decibels maybe used in a threshold search as screening test.…”