Chloral Hydrate Administered by a Dedicated Sedation Service Can Be Used Safely and Effectively for Pediatric Ophthalmic Examination

Karaoui, Mohammed; Varadaraj, Varshini; Muñoz, Beatriz; Collins, Megan E.; Aljasim, Leyla Ali; Naji, Esam Al; Hamweyah, Karam; Shamrani, Mohammed Al; Craven, E. Randy; Friedman, David S.

doi:10.1016/j.ajo.2018.05.003

Cited by 16 publications

(4 citation statements)

References 32 publications

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“…In general, there were no obvious clinical adverse effects presented in this study, and were similar to those currently reported [13][14][15]. However, several studies fund that the adverse effects of chloral hydrate can be bradycardia, apnea and decreased oxygen saturation [16].…”

Section: Discussionsupporting

confidence: 89%

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Qiu¹,

Huang²

2020

SJCM

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Section: Discussionsupporting

confidence: 89%

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Qiu¹,

Huang²

2020

SJCM

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“…Given the young age and clinical features of our subjects, we offered sedation (50 mg/kg chloral hydrate at a maximum dose of 1 g administered rectally). In a recent review of over 300 children, Karaoui et al have demonstrated the safety and efficacy of chloral hydrate for use in paediatric sedation 36 . Children were scanned 15-20 min after sleep onset, as a comparable stage of slow wave sleep was achieved within this timeframe as during an afternoon nap 37 .…”

Section: Image Acquisitionmentioning

confidence: 99%

Symptom improvement in children with autism spectrum disorder following bumetanide administration is associated with decreased GABA/glutamate ratios

et al. 2020

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Bumetanide has been reported to alter synaptic excitation-inhibition (E-I) balance by potentiating the action of γ-aminobutyric acid (GABA), thereby attenuating the severity of autism spectrum disorder (ASD) in animal models. However, clinical evidence of its efficacy in young patients with ASD is limited. This was investigated in the present clinical trial of 83 patients, randomised to the bumetanide group (bumetanide treatment, 0.5 mg twice daily) or the control group (no bumetanide treatment). Primary [Children Autism Rating Scale (CARS)], secondary [Clinical Global Impressions (CGI)], and exploratory [inhibitory (γ-aminobutyric acid, GABA) and excitatory (glutamate, Glx) neurotransmitter concentrations measured in the insular cortex (IC) and visual cortex (VC) by magnetic resonance spectroscopy (MRS)] outcome measures were evaluated at baseline and at the 3-month follow-up. Side effects were monitored throughout the treatment course. Compared with the control group, the bumetanide group showed significant reduction in symptom severity, as indicated by both total CARS score and number of items assigned a score ≥ 3. The improvement in clinical symptoms was confirmed by CGI. GABA/Glx ratio in both the IC and VC decreased more rapidly over the 3-month period in the bumetanide group than that in the control group. This decrease in the IC was associated with the symptom improvement in the bumetanide group. Our study confirmed the clinical efficacy of bumetanide on alleviating the core symptoms of ASD in young children and it is the first demonstration that the improvement is associated with reduction in GABA/Glx ratios. This study suggests that the GABA/Glx ratio measured by MRS may provide a neuroimaging biomarker for assessing treatment efficacy for bumetanide.

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“…age of 2 years and 75 mg/kg over the age of 2 years [4], while another suggested children younger than 6 months received a target dose of 50 mg/kg, and all others received a target dose of 100 mg/kg [13]. There was no known the dosage threshold in different ages.…”

Section: Plos Onementioning

confidence: 99%

Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients

Cui

Guo

et al. 2021

PLoS ONE

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Study objective In Asian countries, oral chloral hydrate is the most commonly used sedative for non-invasive procedures. Theoretically, mild sleep deprivation could be considered as one of assisted techniques. However, there is no consensus on sleep deprivation facilitating the sedation during non-painful procedures in children. The aim of our study is to analyze the clinical data of children undergoing non-invasive procedural sedation retrospectively and to evaluate the association between mild sleep deprivation and sedative effects in non-invasive procedures. Measurements Consecutive patients undergoing chloral hydrate sedation for non-invasive procedures between December 1, 2019 to June 30, 2020 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with sleep deprivation and non-sleep deprivation. The primary outcome was the failure rate of sedation with the initial dose. The secondary outcomes included the failure rate of sedation after supplementation of chloral hydrate, the incidence of major and minor adverse events, initial and supplemental dose of chloral hydrate, and the length of sedation time. Main results Of the 7789 patients undergoing chloral hydrate sedation, 6352 were treated with sleep deprivation and 1437 with non-sleep deprivation. After propensity score matching, 1437 pairs were produced. The failure rate of sedation with initial chlorate hydrate was not significantly different in two groups (8.6% [123/1437] vs. 10.6% [152/1437], p = 0.08), nor were the failure rates with supplemental chlorate hydrate (0.8% [12/1437] vs. 0.9% [13/1437], p = 1) and the length of sedation time (58 [45, 75] vs. 58 [45, 75] min; p = 0.93). Conclusions The current results do not support sleep deprivation have a beneficial effect in reducing the pediatric chloral hydrate sedation failure rate. The routine use of sleep deprivation for pediatric sedation is unnecessary.

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Chloral Hydrate Administered by a Dedicated Sedation Service Can Be Used Safely and Effectively for Pediatric Ophthalmic Examination

Cited by 16 publications

References 32 publications

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Symptom improvement in children with autism spectrum disorder following bumetanide administration is associated with decreased GABA/glutamate ratios

Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients

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