Moderate Sedation for Echocardiography of Preschoolers

Abstract

Preschoolers frequently require sedation for echocardiograms. This study compared various sedation drugs at the authors' institution, as well as the charges for moderate versus deep sedation. From 2001 to 2007, sedation was administered to 703 patients ages 2 to 4 years. Four drug regimens were used: chloral hydrate (CH), chloral hydrate with diphenhydramine (CH + D), chloral hydrate with hydroxyzine hydrochloride (CH + H), and midazolam. The mean onset of sedation was 37 min, and the mean duration of sedation was 47 min. The CH group fell asleep the most quickly (30 min; p < 0.001), and the CH + D patients experienced the most prolonged sedations (13%; p < 0.001). Studies were completed by 97% of the chloral hydrate group, 98% of the CH + D group, and 94% of the CH + H group compared with 66% of the midazolam group (p < 0.001). Complications (7.4%) were minor and not significant for any particular medication. The charges for moderate sedation averaged $709 compared with $3,628 for deep sedation. The findings demonstrated that chloral hydrate was the fastest-acting agent and had a high success rate with minimally prolonged sedations. The low complication rate for chloral hydrate, and the much lower cost for its use to induce moderate sedation have made chloral hydrate our preference for the echocardiographic sedation of preschoolers.

Histamine and H1-antihistamines: Celebrating a century of progress

“…They are also used for treatment of serotonin syndrome, anxiety, acute agitation, akathisia, and migraine headaches. 1,18,[86][87][88] Dimenhydrinate, diphenhydramine, meclizine, and promethazine block the histaminergic signal from the vestibular nucleus to the vomiting center in the medulla. They are used for prevention and treatment of nausea and vomiting during pregnancy, chemotherapy, and the postoperative period and for prevention and treatment of motion sickness, vertigo, and related disorders.…”

“…[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] Atopic dermatitis. Histamine acts as a pruritogen through H 4 -receptors in patients with atopic dermatitis, and other mediators, including IL-31 and other cytokines, play an important role.…”

Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures

“…Studies in dentistry10 12 and echocardiography11 also demonstrated savings for conscious sedation compared with GA. The paediatric dentistry study by Jameson et al 10 showed the mean cost of GA per child to be £359.91, 46.6% more costly than conscious sedation (£245.47) using combined techniques such as inhaled nitrous oxide with sevoflurane or intravenous agents such as midazolam and fentanyl.…”

Oral midazolam versus oral triclofos for sedation of children for computed tomography scan - a randomized clinical trial

“…11,12,13 Higher doses of oral midazolam have been used in pediatric dentistry, echocardiography and in neuro-imaging studies as well. 2,13,14 We chose the dose of 0.75 mg/kg oral midazolam for our study.…”