Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis

Cui, Yu; Guo, Lei; Mu, Qixia; Kang, Lu; Chen, Qin; Wu, Qunying; He, Yani; Tang, Min

doi:10.1007/s40272-022-00511-4

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Determining risk factors for failed sedation is crucial for establishing the safety and efficacy of the combination of intranasal dexmedetomidine with oral midazolam for noninvasive procedures in pediatric patients outside of the operating room. Previous studies [27][28][29] analyzing risk factors for failed sedation in children have shown that history of previous sedation failure, higher ASA score, higher weight, and older age increase the likelihood of sedation failure, which is consistent with our results. Li et al [22] identified a history of sedation failure as the sole risk factor for sedation failure.…”

Section: Discussionsupporting

confidence: 93%

The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam

Zhou,

Zhao,

et al. 2023

Eur J Pediatr

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Procedural sedation for diagnostic examination is a common practice in children. The study aims to analyze the sedative effect and safety of intranasal dexmedetomidine combined with oral midazolam in outpatient pediatric procedural sedation across different age groups and to assess the incidence of sedation failure. From February 2021 to September 2021, children who underwent procedural sedation were retrospectively enrolled. The children were divided into 4 groups based on age: the infant group (0 to 1 year old), toddler group (1 to 3 years old), preschool group (3 to 6 years old), and school-age group (6 to 12 years old). Two-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam were used for sedation. The sedation success rate after rescue, sedation success rate, onset time of sedation, and the sedation time were recorded. The incidence of adverse events and the risk factors for sedation failure were also analyzed. A total of 4758 patients were identified. After exclusion, 3149 patients were ultimately enrolled. The combination of 2-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam resulted in a total success rate of 99.7% and a sedation success rate of 91.4%. The sedation success rate varied among the four groups: 90.2% in the infant group, 93.1% in the toddler group, 92.7% in the preschool group, and 78.4% in the school-age group. The sedation success rate was significantly lower in the school-age group compared to the other three groups (P < 0.001). The onset time of sedation was shorter in infant (22 min, IQR: 18–28 min, P < 0.001) and longer in the school-age group (30 min, IQR: 25–35 min, P < 0.05). Additionally, the infants had a longer sedation time (110 min, IQR: 90–135 min, P < 0.001) and a higher rate of delayed recovery (27.5%, all P < 0.001). The incidence of adverse events was low (4.70%), which bradycardia (2.03%) being the most common. Age (0–1 year and > 6 years), weight, ASA class II, and history of failed sedation were identified as risk factors of sedation failure. Conclusion: Intranasal administration of 2-mcg/kg dexmedetomidine combined with oral administration of 0.5-mg/kg midazolam was found to be efficient and safety for pediatric procedural sedation. Different age groups of children exhibited distinct sedation characteristics, and age was identified as a risk factor affecting the efficacy of sedation. What is Known:• Procedural sedation for diagnostic examination is a common practice in children.• The combination of dexmedetomidine with midazolam can improve sedative effects. What is New:• The success rate of sedation using a combination of 2-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam was significantly lower in school-age children as compared to infants, toddlers, and preschoolers.• The onset time of sedation increased with age, and the sedation time was found to be longer in infant patients.

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Section: Discussionsupporting

confidence: 93%

The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam

Zhou,

Zhao,

et al. 2023

Eur J Pediatr

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“…In many countries, chloral hydrate is no longer available unless specially compounded. However, it is also used in developing countries such as China [3] and Turkey [4], as well as in some developed countries (South Korea [5], Japan [6], Spain [7], and Canada [8]). However, concerns over the use of chloral hydrate have increased due to serious adverse events [9], while other authors still support the use of chloral hydrate for sedation outside the operating room [7,10], especially for non-anesthesiologist-led sedation.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, sedation failure rates associated with chloral hydrate have been reported to be up to 28% [11]. Risk factors associated with chloral hydrate sedation failure are heavier weight, patients with a history of sedation or sedation failure, and patients undergoing MRI or two or more procedures simultaneously, which have been well studied [3].…”

Section: Introductionmentioning

confidence: 99%

Daytime Variation of Chloral Hydrate-Associated Sedation Outcomes: A Propensity-Matched Cohort Study

Cui

Guo

et al. 2023

JCM

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Background: Physiological processes influencing a drugs’ efficacy change substantially over the course of the day. However, it is unclear whether there is an association between the sedative success rate of chloral hydrate and the time of day. We conducted a retrospective study of 41,831 cases, to determine if there was a difference in sedation success rate with chloral hydrate in children seen in the morning and afternoon. Methods: Patients who accepted the sedation service were included. Eligible patients were divided into two cohorts of morning and afternoon cases, according to the time of day when the initial dose of chloral hydrate was administered. To ensure that the two groups were comparable, a propensity score matching method was utilized. Results: The success rate with the initial dose of chloral hydrate was higher in patients who received sedation services in the afternoon. In the subgroup analysis, the afternoon cases had a higher sedation success rate compared to the morning cases in male patients; whereas, in female patients, no difference was detected between the morning versus afternoon cases. Conclusions: These results show that the afternoon cases had a higher sedation success rate than the morning cases, despite the afternoon cases receiving relatively lower initial dose than the morning cases. However, the clinical significance remains to be discussed, and further prospective studies are needed to validate the findings.

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Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam

Cui

Gong

et al. 2023

Pediatr Res

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Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis

Cited by 4 publications

References 27 publications

The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam

The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam

Daytime Variation of Chloral Hydrate-Associated Sedation Outcomes: A Propensity-Matched Cohort Study

Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam

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