Chloral hydrate as a sedating agent for neurodiagnostic procedures in children

Fong, Choong Yi; Tay, Chee Geap; Ong, Lai Choo; Lai, Nai Ming

doi:10.1002/14651858.cd011786.pub2

Cited by 21 publications

(15 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All participants underwent MRI examinations using the same 3.0-T scanner (Signa HDxt, GE Healthcare, Milwaukee, WI) with an 8-channel head coil at the Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University. To reduce motion artifacts and facilitate the MRI examination, all children were adjusted while sleeping, and a relatively small dose of chloral hydrate (10%, 25-50 mg/kg) was administered on obtaining the parent's approval for infants who could not cooperate with the MRI scan (29,30). Then, we followed up on adverse drug reactions in children who received chloral hydrate within 24 h following MRI examinations.…”

Section: Mri Data Acquisitionmentioning

confidence: 99%

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Salimeen

Liu

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Background: Simple febrile seizures (SFS) and epilepsy are common seizures in childhood. However, the mechanism underlying SFS is uncertain, and the presence of obvious variances in white matter (WM) integrity and glymphatic function between SFS and epilepsy remain unclear. Therefore, this study aimed to investigate the differences in WM integrity and glymphatic function between SFS and epilepsy.Material and Methods: We retrospectively included 26 children with SFS, 33 children with epilepsy, and 28 controls aged 6–60 months who underwent magnetic resonance imaging (MRI). Tract-based spatial statistics (TBSS) were used to compare the diffusion tensor imaging (DTI) metrics of WM among the above-mentioned groups. T2-weighted imaging (T2WI) was used to segment the visible Virchow-Robin space (VRS) through a custom-designed automated method. VRS counts and volume were quantified and compared among the SFS, epilepsy, and control groups. Correlations of the VRS metrics and seizure duration and VRS metrics and the time interval between seizure onset and MRI scan were also investigated.Results: In comparison with controls, children with SFS showed no significant changes in fractional anisotropy (FA), axial diffusivity (AD), or radial diffusivity (RD) in the WM (P > 0.05). Decreased FA, unchanged AD, and increased RD were observed in the epilepsy group in comparison with the SFS and control groups (P < 0.05). Meanwhile, VRS counts were higher in the SFS and epilepsy groups than in the control group (VRS_SFS, 442.42 ± 74.58, VRS_epilepsy, 629.94 ± 106.55, VRS_control, 354.14 ± 106.58; P < 0.001), and similar results were found for VRS volume (VRS_SFS, 6,228.18 ± 570.74 mm3, VRS_epilepsy, 9,684.84 ± 7,292.66mm3, VRS_control, 4,007.22 ± 118.86 mm3; P < 0.001). However, VRS metrics were lower in the SFS group than in the epilepsy group (P < 0.001). In both SFS and epilepsy, VRS metrics positively correlated with seizure duration and negatively correlated with the course after seizure onset.Conclusion: SFS may not be associated with WM microstructural disruption; however, epilepsy is related to WM alterations. Seizures are associated with glymphatic dysfunction in either SFS or epilepsy.

show abstract

Section: Mri Data Acquisitionmentioning

confidence: 99%

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Salimeen

Liu

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…However, sedation protocol based on children with DD/ID has not been well-established even though the incidence of side effects by sedation was found to be threefold higher than in children without DD/ID [ 2 ]. Chloral hydrate (CH), a non-opiate and non-benzodiazepine sedative hypnotic drug, has been used widely over the last two decades given its cost-effective profile and sedative-hypnotic potential [ 3 ]. CH is recommended for painless procedures in pediatric patients who have difficulty cooperating with neurodiagnostic investigations [ 3 , 4 ], but only a small number of studies has reported its use in pediatric patients with DD/ID.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Chloral Hydrate on Brain MRI in Children with Developmental Delay/Intellectual Disability Comparing with Normal Intelligence: Single Tertiary Center Experience

Moon

Han

2021

Children

View full text Add to dashboard Cite

Neurodiagnostic investigation requirements are expanding for diagnostic and therapeutic purposes in children, especially in those with developmental delay/intellectual disability (DD/ID). Thus, determination of optimal sedatives to achieve successful sedation and immobility without further neurological compromise is important in children with DD/ID. The purpose of this study is to assess the effectiveness and adverse reactions of chloral hydrate (CH) for brain magnetic resonance imaging (B-MRI) in children with DD/ID compared to those with normal intelligence (NI). We performed a retrospective chart review of children aged from 1 day to 12 years who required elective sedation using CH for B-MRI. About 730 cases (415 with DD/ID and 315 with NI) of CH sedation were conducted for B-MRI. Children with DD/ID showed a higher failure rate (22%) than did those with NI (6%); additional CH and prolonged sedation time were required. There was no difference in incidence of adverse reactions between DD/ID and NI groups (p = 0.338). Older or heavier children with DD/ID (p = 0.036 and p = 0.013, respectively), as well as those diagnosed with epilepsy or neuropsychiatric disorders showed higher risk of sedation failure (p < 0.001 for each). In conclusion, CH was a suboptimal sedative drug for children with DD/ID compared with those with NI. Other alternative or supplementary sedatives should be taken into consideration especially for those vulnerable groups.

show abstract

“…However, a previous meta-analysis only compared the efficacy of CH versus Dex with respect to on neurodiagnostic procedures and sedation. [ 14 , 15 ] Recently, novel RCTs [ 16 – 18 ] have been published, and the efficacy and safety of CH versus Dex when used as monosedatives for sedation in pediatrics has not yet been systematically reviewed. We included studies of all types of surgical or diagnostic procedures.…”

Section: Introductionmentioning

confidence: 99%

Comparison of dexmedetomidine with chloral hydrate as sedatives for pediatric patients

et al. 2020

View full text Add to dashboard Cite

Background: Dexmedetomidine (Dex) and chloral hydrate (CH) are the most frequently used sedative agents in pediatric patients. We aimed to systematically review the literature comparing the efficacy and safety of Dex and CH for sedation in pediatric patients. Methods: Seven electronic databases and 3 clinical trial registry platforms were searched for articles published prior to October 2019. Randomized controlled trials (RCTs) evaluating the efficacy and safety of Dex versus CH for sedation in children were examined by 2 reviewers. The extracted information included the success rate of sedation, sedation latency, sedation duration, sedation recovery time, and adverse events. Moreover, the extracted data included 5 subgroups: the effects of 1, 1.5, 2, 2.5, and 3 μg/kg doses of Dex were compared with the effect of CH on the success rate of sedation. We also formed separate subgroups for different types of adverse events (incidence of vomiting, hypotension, bradycardia, etc). The outcomes were analyzed by Review Manager 5.3 software and are expressed as relative risks (RR) or the mean difference (MD) with the 95% confidence interval (CI). Heterogeneity was assessed with I-squared ( I 2 ) statistics. Results: A total of 15 RCTs involving 2128 children with Dex versus CH for sedation were included in the meta-analysis. The dose range of Dex ranged from 1 to 3 μg/kg. Compared with CH, the Dex group had a significantly higher success rate of sedation (RR = 1.14, 95% CI [1.05, 1.25], I 2 = 79%, P = .003). Additionally, subgroup analysis revealed that there was no significant difference in the success rate of sedation between the CH group and the 1, 1.5, 2.5, and 3 μg/kg Dex groups; only the 2 μg/kg Dex group had a significantly higher success rate than the CH group (RR = 1.15, 95% CI [1.03, 1.29], I 2 = 80%, P = .02). There was no significant difference in the number of subjects who required 2 doses or the duration of sedation between the CH and Dex groups. Furthermore, compared with the Dex group, the CH group had a significantly longer sedation latency (MD = –3.54, 95% CI [–5.94, –1.15], I 2 = 95%, P = .004), sedation recovery time (MD = –30.08, 95% CI [–46.77, –13.39], I 2 = 99%, P = .0004), and total time from sedative administration to discharge (MD = –12.73, 95% CI [–15.48, –9.97], I 2 = 0%, P < .05), as well as a higher number of adverse events in total (RR = 0.25, 95% CI [0.11, 0.61], I 2 = 89%, P = .002). Moreover, the subgroup analysis of adverse events revealed that ...

show abstract

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children

Cited by 21 publications

References 65 publications

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Effectiveness of Chloral Hydrate on Brain MRI in Children with Developmental Delay/Intellectual Disability Comparing with Normal Intelligence: Single Tertiary Center Experience

Comparison of dexmedetomidine with chloral hydrate as sedatives for pediatric patients

Contact Info

Product

Resources

About