A Randomized Controlled Trial Comparing Intranasal Midazolam and Chloral Hydrate for Procedural Sedation in Children

Stephen, Marie Christy Sharafine; Mathew, John; Varghese, Ajoy Mathew; Kurien, Mary; Mathew, George

doi:10.1177/0194599815599381

Cited by 16 publications

(19 citation statements)

References 28 publications

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“…The lower efficacy of midazolam in that study may be related to the low dose of 0.2 mg/kg. Stephen et al (21) concluded successful sedation leading to completion of procedure was achieved in 95% of children with chloral hydrate compared with 51% for INM. Probably the differences between individuals, race and age range of the patients led to these differences.…”

Section: Discussionmentioning

confidence: 99%

“…INM can be rapidly absorbed through the highly vascularized nasal mucosa, resulting in a rapid and reliable onset of action. The shorter half-life, ease of administration, predictability and increased bioavailability by circumventing first-pass metabolism makes it a useful drug in the ED setting (17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

“…The dose of INM used in different studies range between 0.2 mg/kg and 0.5 mg/kg. The most common adverse effects reported following INM are burning or irritation in the nose and a bitter taste in the mouth (17)(18)(19)(20)(21)(22)(23). Aerosolized administration of midazolam on mucosal surfaces may enhance drug delivery.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Intranasal Midazolam Versus Chloral Hydrate as Sedation for Quality Computed Tomography Imaging in Children

Heydari¹,

Shabani²,

Majidinejad³

et al. 2019

jpr

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The purpose of this study was to compare the efficacy and safety of aerosolized intranasal midazolam (INM) compared to oral chloral hydrate (OCH) as procedural sedatives in pediatric patients undergoing computed tomography (CT) imaging. Materials and Methods: A prospective, randomized, double-blind clinical trial was utilized in children aged 1 to 8 years who presented to the ED with minor head trauma and were scheduled to undergo brain CT scan. One hundred and sixty children were randomized to receive INM 0.3 mg/kg with oral placebo or 75 mg/kg OCH with intranasal placebo. If the patient was not adequately sedated 20 minutes after the initial dose, a second dose of the same medication at one-third of the initial dosage was given. The sedation level of patients after drug administration was assessed using the Ramsay sedation scale. Results: Both groups were comparable with respect to age, male to female ratio, weight, and baseline vital signs. Sixty two children (77.50%) in the INM group and 59 children (73.42%) in the OCH groups reached a Ramsay score of four, respectively (p=0.55). There was no significant difference in regards to the time to become adequately sedated (21.32±6.54 vs 23.62±7.40, p=0.173) and time for completing CT scan (30.37±7.18 vs 32.96±7.85, p=0.185). However, the time to recovery was shorter for the INM group (72.52±10.17 vs 88.10±10.27, p=0.001). No serious side effects were seen in the study groups (p=0.836). The majority of parents were somewhat to very satisfied, 83.54% and 81.25% in the OCH and INM groups, respectively (p=0.928). Conclusion: INM can be used to sedate children between 1 to 8 years who are to undergo CT imaging of brain with a comparable rate of efficacy and safety to OCH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Intranasal Midazolam Versus Chloral Hydrate as Sedation for Quality Computed Tomography Imaging in Children

Heydari¹,

Shabani²,

Majidinejad³

et al. 2019

jpr

View full text Add to dashboard Cite

show abstract

“…However, it is unreliable, for example Barzegari et al found that this dose resulted in an average onset time of 55 min whilst Majidinejad et al found that only 15% of children given this dose were adequately sedated for CT scanning. Oral chloral hydrate, given in a dose of 50 mg.kg −1 appears to be more reliable ; however, a relatively high proportion of children are liable to spit out the drug.…”

Section: Choice Dose and Mode Of Administration Of Sedative Agentsmentioning

confidence: 99%

Sedation in children - is it time to change our practice?

Bailey

2016

Anaesthesia

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“…However, it is unreliable, for example Barzegari et al [12] found that this dose resulted in an average onset time of 55 min whilst Majidinejad et al [13] found that only 15% of children given this dose were adequately sedated for CT scanning. Oral chloral hydrate, given in a dose of 50 mg.kg À1 appears to be more reliable [14]; however, a relatively high proportion of children are liable to spit out the drug.…”

Section: Choice Dose and Mode Of Administration Of Sedative Agentsmentioning

confidence: 99%

How clinical registries can make a difference in hip fracture care

Neuman

2016

Anaesthesia

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A Randomized Controlled Trial Comparing Intranasal Midazolam and Chloral Hydrate for Procedural Sedation in Children

Cited by 16 publications

References 28 publications

Efficacy and Safety of Intranasal Midazolam Versus Chloral Hydrate as Sedation for Quality Computed Tomography Imaging in Children

Efficacy and Safety of Intranasal Midazolam Versus Chloral Hydrate as Sedation for Quality Computed Tomography Imaging in Children

Sedation in children - is it time to change our practice?

How clinical registries can make a difference in hip fracture care

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