Question 1 Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging?: Table 1

Hare, Michelle

doi:10.1136/archdischild-2011-301116

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Chloral hydrate has been widely used as sedative in children undergoing clinical procedures. Its prescription in pediatrics is recommended for certain diagnostic procedures such as neurological imaging, − echocardiography, and auditory brainstem response testing when the patients do not respond to other agents …”

Section: Introductionmentioning

confidence: 99%

Atomistic Model for Simulations of the Sedative Hypnotic Drug 2,2,2-Trichloroethanol

et al. 2018

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2,2,2-Trichloroethanol (TCE) is the active form of the sedative hypnotic drug chloral hydrate, one of the oldest sleep medications in the market. Understanding of TCE’s action mechanisms to its many targets, particularly within the ion channel family, could benefit from the state-of-the-art computational molecular studies. In this direction, we employed de novo modeling aided by the force field toolkit to develop CHARMM36-compatible TCE parameters. The classical potential energy function was calibrated targeting molecular conformations, local interactions with water molecules, and liquid bulk properties. Reference data comes from both tabulated thermodynamic properties and ab initio calculations at the MP2 level. TCE solvation free energy calculations in water and oil reproduce a lipophilic, yet nonhydrophobic, behavior. Indeed, the potential mean force profile for TCE partition through the phospholipid bilayer reveals the sedative’s preference for the interfacial region. The calculated partition coefficient also matches experimental measures. Further validation of the proposed parameters is supported by the model’s ability to recapitulate quenching experiments demonstrating TCE binding to bovine serum albumin.

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Section: Introductionmentioning

confidence: 99%

Atomistic Model for Simulations of the Sedative Hypnotic Drug 2,2,2-Trichloroethanol

et al. 2018

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“…Several studies have shown that midazolam is as effective if not more effective than chloral hydrate for various procedures [21,22]. Other studies have shown chloral hydrate resulted in better sedation than other sedation medications in pediatric patients [23,24]. However, due the potential severe adverse effects from chloral hydrate, we recommend alternative agents to chloral hydrate be used in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Chloral Hydrate Poisonings and Death Following Outpatient Procedural Sedation

et al. 2014

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Introduction Chloral hydrate has been used medicinally since the 1800 s as a sedative hypnotic, most commonly for procedural sedation. As it is administered orally and available in a liquid formulation, it is used almost exclusively in pediatric patients despite many safer and more effective alternative agents being available. Case Series We present three cases of pediatric chloral hydrate poisoning, all occurring following procedural sedation in outpatient clinic settings and presenting to the emergency department. The ages ranged from 15 months to 4 years of age and all required resuscitation. Unfortunately, the 4-yearold died. Conclusion Choral hydrate is associated with significant adverse effects, including death, and safer alternatives for pediatric procedural sedation should be sought and utilized. There are a number of more effective sedative agents with more predictable pharmacokinetic and safety profiles than chloral hydrate including parenteral and oral agents. The practice of pre-procedure sedation should be performed only in a supervised setting where cardiorespiratory monitoring can occur in all cases.

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“…Furthermore, the average latency time by midazolam is 117 ± 5 minute and sedation duration is about 45 ± 12 minutes. 34,38 Compared with midazolam, CH has shown more profound and long-lasting sedation 39 In clinical use, other studies reported that chloral hydrate was more effective than midazolam in facilitating the completion of painless imaging studies, although it has a longer onset and duration, and reported minimal adverse events 30,40 Moreover, the reports on midazolam were not always positive despite his rapid action onset and short duration of action which does not encourage the health care provider shift from the old CH to the new midazolam as a sedative agent. 34,41 CH syrup remains consequently cheaper and even more effective than the rectal midazolam, given its short latency time to cause sedation of children.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

Omar¹,

Yacine²,

Karim³

et al. 2022

IJDDT

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To develop a stable chloral hydrate (CH) syrup and to test its clinical efficacy in inducing painless sedation during diagnostic imaging examinations in children under 4 years of age. For the physico-chemical tests, the vials were stored at + 5 and + 25°C and the analysis was carried out for 60 days. The microbiological tests were performed in 4 days of analysis. The prospective clinical study was conducted in 33 infants and children after receiving CH syrup orally for sedation prior to magnetic resonance imaging (MRI). After two months of storage, the average concentrations in all tests were greater than 95% of the initial chloral hydrate concentration. No microbiological growth was noted after 60 days of storage. The clinical use of syrup in children resulted in effective sedation in 100% of children and rare side effects. Compared to midazolam, chloral hydrate is more effective for sedating children under 5 years of age and is significantly less expensive. The prescription of 5% CH syrup for sedation prior to imaging diagnosis has well-established efficacy. However, the safe use of chloral hydrate in infants and children under 5 years of age should be in accordance with international recommendations.

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Question 1 Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging?: Table 1

Cited by 8 publications

References 6 publications

Atomistic Model for Simulations of the Sedative Hypnotic Drug 2,2,2-Trichloroethanol

Atomistic Model for Simulations of the Sedative Hypnotic Drug 2,2,2-Trichloroethanol

Pediatric Chloral Hydrate Poisonings and Death Following Outpatient Procedural Sedation

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

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