The Safety and Efficacy of Chloral Hydrate Sedation for Pediatric Ophthalmic Procedures: A Retrospective Review

Abstract

The use of chloral hydrate sedation for ophthalmic evaluation and imaging was safe and effective in this patient population with a high rate of procedure completion.

Safety and efficacy of chloral hydrate for procedural sedation in paediatric ophthalmology: a systematic review and meta-analysis

“…One was a case report of accidental CH overdose,10 five papers concerned electrodiagnostic testing (EDT),11–15 one paper pertained to IOP measurement,16 and the remaining studies reported on medium to large series of patients being sedated for a variety of ophthalmic examinations (eg, refraction, ocular imaging, contact lens fitting, suture removal, EDTs, etc) 3 4 17–19. One report evaluated the cost-effectiveness of clinic-based CH sedation in comparison to general anaesthesia for paediatric ophthalmic examinations 5…”

“…In the recent large series (West et al 3 with 1509 episodes, Wilson et al 4 with 380 procedures, and Burnett et al 5 with 122 cases), more extensive vital sign monitoring is reported, including heart rate, respiratory rate and oxygen saturation, either continuously3 or every 5–10 min 4 5…”

“…AE, otherwise known as side effects, are only defined in a few reports, for example, oxygen desaturation below 95%, or heart rate decrease by ≥20%, etc 3 4. The AE reported most commonly were not serious, for example, nausea, transient vomiting, prolonged sedation, excitement/restlessness and paradoxical reaction, and did not require intervention or hospitalisation.…”

“…The AE reported most commonly were not serious, for example, nausea, transient vomiting, prolonged sedation, excitement/restlessness and paradoxical reaction, and did not require intervention or hospitalisation. These AE are reported to occur in a small percentage, usually <10%, of patients receiving the drug 3 4…”

“…Concerns have been raised about severe adverse events (AE) related to its use, mainly as a result of overdosage2 and in some countries (eg, the USA) it is not included in the list of approved drugs. However, recent studies reveal that some paediatric ophthalmology units use it routinely in hospital-based outpatient nurse-led clinics and report large series with no severe side effects 3 4. This approach has actually been shown to be cost-saving in a cross-over study comparing CH to EUA, without posing morbidity or mortality risks 5.…”