Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests

Necula, Violeta; Stamate, Mirela Cristina; Blebea, Cristina Maria; Cozma, Sebastian

doi:10.1016/j.ijporl.2019.109605

Cited by 8 publications

(8 citation statements)

References 24 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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“…It is absorbed in the gastrointestinal tract and reaches peak plasma concentrations in 30–60 min; however, this drug is not safe enough because its long-acting metabolite, trichloroethanol, has a half-life of 12–24 h and is hepatotoxic ( 19 ). Chloral hydrate can cause respiratory depression in children, accompanied by delayed sedation, nausea and vomiting ( 20 , 21 ), so its application is limited. Additionally, animal experiments have found that chloral hydrate, as a γ-aminobutyric acid (GABA) receptor agonist and N-methyl-D-aspartate (NMDA) receptor antagonist, may affect brain development and induce neurotoxicity or neuronal cell apoptosis ( 22 – 24 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

2022

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ObjectiveThis meta-analysis aims to evaluate the sedative efficacy and safety of intranasal administration of dexmedetomidine (DEX) compared with oral chloral hydrate for Computed tomography (CT) or Magnetic Resonance Imaging (MRI) examination in Children.MethodsCochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and China WanFang Databases were searched to collect randomized controlled trials (RCTs) investigating intranasal DEX (test group) vs. oral chloral hydrate (control group) in pediatric CT/MRI examinations up to December 30, 2021. The data were analyzed using Stata 15.0 software.ResultsSeven RCTs with 1,846 children were identified. The meta-analysis results showed that the success rate of sedation (RR = 1.14, 95% CI: 1.03–1.26, P = 0.011), sedation onset time [weighted mean difference (WMD) = –0.87, 95% CI: –1.42 to –0.31, P = 0.002], sedation duration (WMD = –9.05, 95% CI:-14.69 to –3.42, P = 0.002), time to awakening (WMD = –9.75, 95% CI:-17.57 to –1.94, P = 0.014), and incidence of nausea and vomiting [relative risk (RR) = 0.09, 95% CI:0.04–0.23, P < 0.001) of the test group were significantly better than those of the control group. However, no significant differences were identified in incidence of hypotension (RR = 1.18, 95% CI: 0.51–2.74) and bradycardia (RR = 1.17, 95% CI: 0.13–22.11) between the two groups.ConclusionIntranasal administration of DEX is superior to oral chloral hydrate for sedation during pediatric CT/MRI examinations and has a better safety profile.

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“…by repositioning the children’s head and providing supplementary oxygen [ 38 ]. Smaller cohorts also showed either no [ 14 ] or only transient cardio-respiratory complications that were treatable with simple measures [ 39 , 40 ]. However, in a review of 1586 children (including 341 aged up to 6 months), 4 patients (0.2%) developed apnea; three of them recovered three patients sponaneously in under 15 seconds, but one child required oxygen ventilation via facemask [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…In general, sedation procedures can be performed very safely in young children. Nonetheless, airway complications, vomiting, agitation, prolonged sleep, and failure to fall asleep have been described [ 14 , 15 ]. On the other hand, the lack of controlled ventilation and intravenous access, which is actually an advantage of the less invasive procedure, may delay treatment of complications.…”

Section: Introductionmentioning

confidence: 99%

Comparison of cerebral oxygen desaturation events between children under general anesthesia and chloral hydrate sedation - a randomized controlled trial

et al. 2022

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Background During pediatric general anesthesia (GA) and sedation, clinicians aim to maintain physiological parameters within normal ranges. Accordingly, regional cerebral oxygen saturation (rScO2) should not drop below preintervention baselines. Our study compared rScO2 desaturation events in children undergoing GA or chloral hydrate sedation (CHS). Methods Ninety-two children undergoing long auditory assessments were randomly assigned to two study arms: CHS (n = 40) and GA (n = 52). Data of 81 children (mean age 13.8 months, range 1–36 months) were analyzed. In the GA group, we followed a predefined 10 N concept (no fear, no pain, normovolemia, normotension, normocardia, normoxemia, normocapnia, normonatremia, normoglycemia, and normothermia). In this group, ENT surgeons performed minor interventions in 29 patients based on intraprocedural microscopic ear examinations. In the CHS group, recommendations for monitoring and treatment of children undergoing moderate sedation were met. Furthermore, children received a double-barreled nasal oxygen cannula to measure end-tidal carbon dioxide (etCO2) and allow oxygen administration. Chloral hydrate was administered in the parent’s presence. Children had no intravenous access which is an advantage of sedation techniques. In both groups, recommendations for fasting were followed and an experienced anesthesiologist was present during the entire procedure. Adverse event (AE) was a decline in cerebral oxygenation to below 50% or below 20% from the baseline for ≥1 min. The primary endpoint was the number of children with AE across the study arms. Secondary variables were: fraction of inspired oxygen (FIO2), oxygen saturation (SpO2), etCO2, systolic and mean blood pressure (BP), and heart rate (HR); these variables were analyzed for their association with drop in rScO2 to below baseline (%drop_rScO2). Results The incidence of AE across groups was not different. The analysis of secondary endpoints showed evidence that %drop_rScO2 is more dependent on HR and FIO2 than on BP and etCO2. Conclusions This study highlights the strong association between HR and rScO2 in children aged < 3 years, whereas previous studies had primarily discussed the role of BP and etCO2. Prompt HR correction may result in shorter periods of cerebral desaturation. Trial registration The study was retrospectively registered with the German Clinical Trials Registry (DRKS00024362, 04/02/2021).

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Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests

Cited by 8 publications

References 24 publications

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Safety and Efficacy of Chloral Hydrate in Outpatient Pediatrics for Sedation

Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

Comparison of cerebral oxygen desaturation events between children under general anesthesia and chloral hydrate sedation - a randomized controlled trial

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