Comparison of chloral hydrate and midazolam for sedation of neonates for neuroimaging studies

McCarver-May, D. G.; Kang, Jun Hong; Aouthmany, Moustafa M.; Elton, Richard L.; Mowery, J. L.; Slovis, Thomas L.; Kauffman, Ralph E.

doi:10.1016/s0022-3476(96)70375-x

Cited by 48 publications

(30 citation statements)

References 10 publications

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“…In a randomized, double-blind trial (stopped after only 16 intubations because of adverse events and reported in a letter to the editor), preterm infants who received midazolam and atropine for intubation had more desaturations, and 29% required cardiopulmonary resuscitation compared with those in the groups that received either atropine alone or no premedication. 32 Midazolam can cause hypotension in both preterm and term infants, [33][34][35][36] decreased cardiac output in older children, 37 and decreased cerebral blood flow velocity in premature infants. 33,38 The studies that demonstrated these effects were not performed as part of premedication for intubation, and the results may not be applicable to the circumstances necessitating endotracheal intubation.…”

Section: Sedationmentioning

confidence: 99%

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar¹,

Denson²,

Mancuso³

et al. 2010

Pediatrics

190

211

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Section: Sedationmentioning

confidence: 99%

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar¹,

Denson²,

Mancuso³

et al. 2010

Pediatrics

190

211

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“…Unfortunately, data in the subgroup of neonates were not reported. In contrast, chloral hydrate (75 mg/ kg) was more effective and had similar side effects when compared to midazolam (0.2 mg/kg intravenous) in a crossover study in seven term neonates [135].…”

Section: Chloral Hydratementioning

confidence: 88%

Sedation in the Neonatal Intensive Care Unit: International Practice

Allegaert

Anker

2014

Pediatric Sedation Outside of the Operating Room

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Inadequate pain management in neonatal life impairs neurodevelopmental outcome because it alters pain thresholds, pain-or stress-related behavior, and physiological responses later in life. However, there are recently also emerging animal experimental and human epidemiological data on the impact of analgo-sedatives on neuro-apoptosis and impaired neurodevelopmental outcome. As a consequence, the management of neonatal pain is in search of a new balance, and these conflicting observations are the main drivers to tailor our pain management in neonates. Adequate pain management is based on prevention, assessment, and treatment with subsequent reassessment. Issues related to prevention and assessment tools are covered. Non-pharmacological (e.g., complementary interventions like facilitated tucking, nonnutritive sucking) and pharmacological (e.g., acetaminophen, opioids, ketamine, propofol) treatment modalities were reviewed and reflect the increased knowledge on neonatal pain management. Each topic ends with some take-home messages that in part also reflect our opinion on the current status of this topic.

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“…Pediatric subspecialty services may develop expertise in administering sedation/analgesia as a specific routine in the endoscopy suite, the cardiac catheterization laboratory, or the radiology department. [11][12][13][14][15][16][17][18] The emergency department is another area where specific drug regimens have been used successfully for short, painful procedures on generally healthy children on an emergency basis. 19 -22 Difficulty may arise when specific regimens are not appropriate for medically complex circumstances.…”

Section: Discussionmentioning

confidence: 99%

The Pediatric Sedation Unit: A Mechanism for Pediatric Sedation

1998

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ABSTRACT. Objectives. We have created a pediatric sedation unit (PSU) in response to the need for uniform, safe, and appropriately monitored sedation and/or analgesia for children undergoing invasive and noninvasive studies or procedures in a large tertiary care medical center. The operational characteristics of the PSU are described in this report, as is our clinical experience in the first 8 months of operation.Methods. A retrospective review of quality assurance data was performed. These data included patient demographics and chronic medical diagnoses, procedure, or study performed; sedative or analgesic medication given; complications (defined prospectively); and sedation and monitoring time. Patient-specific medical records related to the procedure and sedation were reviewed if a complication was noted in the quality assurance data.Results. Briefly, the PSU was staffed with an intensivist and pediatric intensive care unit nurses. Patients were admitted to the PSU and assessed medically for risk factors during sedation. Continuous heart rate, respiratory rate, and pulse oximetry monitoring were used, and blood pressure was determined every 5 minutes. After sedation and stabilization, with monitoring continued, the patient was transported to the site to undergo the procedure or study. The pediatric intensive care unit nurse remained with the patient at all times. All necessary emergency equipment was transported with the patient. After the procedure or study was completed, the patient was returned to the PSU for recovery to predetermined parameters.We were able to analyze 458 episodes of sedation for this review. Procedures and studies included radiologic examinations, cardiac catheterization, orthopedic manipulations, solid organ and bone marrow biopsy, gastrointestinal endoscopy, bronchoscopy, evoked potential measurements, and others. Patients were 2 weeks to 32 years of age. The average time from initiation of sedation to last dose of medication administered was 84 minutes. The average time from initiation of sedation to full recovery was 120 minutes. Sedative and analgesia medications use was not standardized; however, the majority of children needing sedation received propofol or midazolam. For patients requiring analgesia, ketamine or fentanyl was added. In 79 of 458 (12%) sedation episodes, complications were documented. Mild hypotension (4.4%), pulse oximetry <93% (2.6%), apnea (1.5%), and transient airway obstruction (1.3%) were the most common complications noted. Cancellation of 11 (2.4%) procedures was attributable to complications. No long-term morbidity or mortality was seen.Conclusions. Many children require sedation or analgesia during procedures or studies. Safe sedation is best ensured by appropriate presedation risk assessment and with monitoring by a care provider trained in resuscitative measures who is not involved in performing the procedure itself. Uniformity of care in a large institution is a standard met by the creation of a centralized service, with active input from the departmen...

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Comparison of chloral hydrate and midazolam for sedation of neonates for neuroimaging studies

Cited by 48 publications

References 10 publications

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Sedation in the Neonatal Intensive Care Unit: International Practice

The Pediatric Sedation Unit: A Mechanism for Pediatric Sedation

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