Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients

Abstract

Study objective In Asian countries, oral chloral hydrate is the most commonly used sedative for non-invasive procedures. Theoretically, mild sleep deprivation could be considered as one of assisted techniques. However, there is no consensus on sleep deprivation facilitating the sedation during non-painful procedures in children. The aim of our study is to analyze the clinical data of children undergoing non-invasive procedural sedation retrospectively and to evaluate the association between mild sleep deprivation and sedative effects in non-invasive procedures. Measurements Consecutive patients undergoing chloral hydrate sedation for non-invasive procedures between December 1, 2019 to June 30, 2020 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with sleep deprivation and non-sleep deprivation. The primary outcome was the failure rate of sedation with the initial dose. The secondary outcomes included the failure rate of sedation after supplementation of chloral hydrate, the incidence of major and minor adverse events, initial and supplemental dose of chloral hydrate, and the length of sedation time. Main results Of the 7789 patients undergoing chloral hydrate sedation, 6352 were treated with sleep deprivation and 1437 with non-sleep deprivation. After propensity score matching, 1437 pairs were produced. The failure rate of sedation with initial chlorate hydrate was not significantly different in two groups (8.6% [123/1437] vs. 10.6% [152/1437], p = 0.08), nor were the failure rates with supplemental chlorate hydrate (0.8% [12/1437] vs. 0.9% [13/1437], p = 1) and the length of sedation time (58 [45, 75] vs. 58 [45, 75] min; p = 0.93). Conclusions The current results do not support sleep deprivation have a beneficial effect in reducing the pediatric chloral hydrate sedation failure rate. The routine use of sleep deprivation for pediatric sedation is unnecessary.

Prolonged imaging time in the salivagram appears unnecessary for detecting aspiration

“…Holding the child in place may be sufficient for the youngest children, from neonates to 2 years old. Other methods, such as sleep deprivation prior to the scan and feeding the pediatric patient a bottle on the examination table, may be equally effective for most patients (19). Sandbags and entertainment such as video, music, and reading stories may also be effective for patients older than 4 or 5 years old.…”

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

“…Successful CH sedation rate of 88–99% was achieved with an initial dose of 60–100 mg/kg and 94.2% success rate was achieved with a single mean dose of 77.5 mg/kg in previous reports [ 13 , 14 ]. Even at a relatively low dose of CH, the sedation rate reached 90%; after administration of an additional dose of CH, the sedation rate reached 99% [ 15 ]. In this study, although the mean initial and additional CH doses were similar in each group, the failure rate was significantly higher in children with DD/ID (78%) compared with NI (94%).…”

“…CH has disadvantages such as narrow therapeutic index, inter-individual variability, prolonged sedation and recovery times, paradoxical reaction, and inconsistent sedative effects [ 4 , 22 ]. Adverse reactions from CH were rash, gastric irritation, diarrhea, nausea/vomiting, decreased oxygen saturation, prolonged sedation, hypotension, and hyperactivity/irritability/anxiety [ 15 , 28 ]. Despite few fatal adverse effects on the cardiopulmonary system, irritation to the gastric mucosa can lead to aspiration of stomach materials, which can be fatal in sedated children.…”

Correlation between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients in South Korea: a prospective cohort study

“…The study of Ong et al [ 18 ] showed that 55% of children could undergo examinations with natural sleep alone (i.e., without sedation) when partial sleep deprivation was recommended prior to EEG examinations, and Alix et al [ 19 ] reported that an intervention using sleep reduction and melatonin increased the sedation effect during EEG. In contrast, Cui et al [ 21 ] stated that sleep deprivation did not enhance the success rate of chloral hydrate sedation in pediatric patients, and Sury et al [ 22 ] pointed out limitations in the evidence supporting the efficacy of sleep deprivation in aiding sedation and acknowledged the practical difficulties of this approach [ 23 ].…”