Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Abstract

OBJECTIVE. The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution.METHODS. We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed.RESULTS. Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included Ն20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n ϭ 3 [0.3%]), airway obstruction (n ϭ 15 [1.4%]), hypoxia (n ϭ 65 [5.9%]), hypercarbia (n ϭ 40 of 603 [6.6%]), hypotension with poor perfusion (n ϭ 4 [0.4%]), vomiting (n ϭ 4 [0.4%]), and prolonged sedation (n ϭ 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors.CONCLUSIONS. Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this www.pediatrics.org/cgi

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

“…In this risk group, consisting mostly of patients with heart disease, 10.8% had some adverse event, such as decrease in SpO 2 (5.9%), hypercapnia (6.6%), airway obstruction (1.4%), apnea (0.3%), hypotension (0.4%) and vomiting (0.4%). Of the assessed children, 24% showed a decrease in heart rate ≥20%, but only 1.4% decreased heart rate below the normal range for age 11. Major interventions such as face-mask ventilation and volume expansion were necessary in five cases (<0.5%), with tracheal intubation in one of them 11…”

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Sedation in the Neonatal Intensive Care Unit: International Practice

“…There was a moderate decrease in heart rate and blood pressure, while adverse events were observed in 10.8 %: apnea (n = 3), airway obstruction (n = 15), hypoxia (n = 65), hypercarbia (n = 40), hypotension with poor perfusion (n = 4), vomiting (n = 4), and prolonged sedation (n = 36). Adverse events were more common in infants younger than 6 months [129].…”

“…This may result in obstructive apnea, more common in infants or young children with obstructive apnea syndrome, or in neonates with malformations or microretrognathia. Obstructive apnea with secondary bradycardic episodes has been observed in young infants exposed to chloral hydrate to facilitate echocardiography [129]. Case reports on the association of chloral hydrate exposure and unanticipated "cod" death have been described.…”