Use of chloral hydrate as a sedative for auditory brainstem response testing in a pediatric population

Avlonitou, Eirini; Balatsouras, Dimitrios G.; Margaritis, Eleftherios; Giannakopoulos, Polyvios; Douniadakis, Dimitrios; Tsakanikos, Michael

doi:10.1016/j.ijporl.2011.02.010

Cited by 50 publications

(33 citation statements)

References 23 publications

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“…The observed adverse events and their frequency were similar to those described by other authors, that is: paradoxical reactions (1.3%); decrease in SpO 2 (1%); vomiting (0.5%) and bradycardia (0.1%) 9. The report of another large case series, by Avlonitou et al compiled adverse events after sedation with CH for hearing tests in 1903 children up to 14 years of age (568 children under six months of age) 8. In this study, they observed hyperactivity in 8% of cases, vomiting in 11%, mild respiratory discomfort 0.5% and apnea in 0.2% of the cases 8…”

Section: Discussionsupporting

confidence: 81%

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

Wandalsen

Lanza

Nogueira

et al. 2016

Revista Paulista de Pediatria (English Edition)

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Objective:To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests.Methods:All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described.Results:The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications.Conclusions:The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

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Section: Discussionsupporting

confidence: 81%

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

Wandalsen

Lanza

Nogueira

et al. 2016

Revista Paulista de Pediatria (English Edition)

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“…Nevertheless, it is associated with a high success rate in children undergoing CT scanning and auditory brainstem responses. An initial dose of 40 mg.kg −1 for children over six months of age was shown to be successful in 77% of children undergoing auditory brainstem responses . An initial dose of 72 mg.kg −1 was successful in 89% of patients undergoing CT scanning and a mean total dose of 78 mg.kg −1 increased this success to 98% in one study .…”

Section: Introductionmentioning

confidence: 97%

Intranasal dexmedetomidine following failed chloral hydrate sedation in children

Yuen

Song

et al. 2014

Anaesthesia

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SummaryChloral hydrate is the most commonly used sedative for paediatric diagnostic procedures in China with a success rate of around 80%. Intranasal dexmedetomidine is used for rescue sedation in our centre. This prospective investigation evaluated 213 children aged one month to 10 years who were not adequately sedated following administration of chloral hydrate. Children were randomly assigned to receive rescue intranasal dexmedetomidine at 1 lg.kg À1 (group 1), 1.5 lg.kg À1 (group 2) or 2 lg.kg À1 (group 3). The sedation level was assessed every 10 min using a modified observer's assessment of alertness/sedation scale. Successful rescue sedation in groups 1, 2 and 3 were 56 (83.6%), 66 (89.2%) and 51 (96.2%), respectively. Increasing the rescue dose was associated with an increased success rate with an odds ratio of 4.12 (95% CI 1.13-14.98), p = 0.032. We conclude that intranasal dexmedetomidine is effective for sedation in children who do not respond to chloral hydrate.

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“…Chloral hydrate is frequently used for light sedation of newborns to facilitate painless diagnostic procedures that require the patients to be motionless, such as various radiological and neurophysiological tests. [1][2][3][4][5] The recommended dose of chloral hydrate for newborns and infants is 25-50 mg/kg. 6 The sedative effects of chloral hydrate become clinically apparent approximately 20 minutes after oral or rectal administration [7][8][9] and last between 90 7,8 and 165 10 minutes, although they may be prolonged, especially in preterm infants.…”

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confidence: 99%

“…2 In some previous pediatric studies, it has been suggested that chloral hydrate sedation in infants and children is effective and safe, with a relatively low risk of severe respiratory and hemodynamic adverse effects. 1,3,4,8,9 On the other hand, some have reported severe complications of chloral hydrate sedation in children and even death. 11 Chloral hydrate may, like many other sedatives, affect respiratory and cardiovascular function and pose a risk of respiratory depression and hypoxia.…”

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confidence: 99%

“…Previous studies have mainly included older infants and children 3,5,8,9 , relied on intermittent measuring of vital signs 3,4,8,9 or were mostly retrospective, focusing only on clinically apparent adverse events. 1,4,16 To further clarify the impact of chloral hydrate on cardiorespiratory function in term newborns, we analyzed continuously recorded cardiorespiratory parameters, including arterial oxygen saturation (SpO 2 ), end-tidal CO 2 (ETCO 2 ), the apnea-hypopnea index and the respiratory and heart rates, before and after the administration of oral chloral hydrate at a dose of 40 mg/kg.…”

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confidence: 99%

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Cardiorespiratory parameters in newborns during sedation with chloral hydrate

et al. 2020

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We commonly use chloral hydrate sedation in newborns, though its cardiorespiratory side effects have not yet been fully investigated. Our study aimed to analyze the impact of chloral hydrate on cardiorespiratory parameters in term newborns. We performed a prospective, pre-post single-arm interventional study in 42 term, respiratorily and hemodynamically stable newborns. Oxygen saturation (SpO 2), end-tidal CO 2 (ETCO 2), the apnea-hypopnea index and the respiratory and heart rates were recorded by polygraphy, starting 0.5-1 hour before oral administration of chloral hydrate at a dose of 40 mg/kg and ceasing 4 hours post-administration. After administration of chloral hydrate, the mean basal SpO 2 dropped by 2.0% (from 97.1% to 95.1%; p<0.001) and the mean basal ETCO 2 increased by 3.9 mmHg (25.6 to 29.5 mmHg; p<0.001). We found a significant decrease in the minimal SpO 2 values (p<0.001) and an increase in the percentage of time spent with SpO 2 <95% and <90% (p<0.001). The mean increase in the estimated apnea-hypopnea index was 3.5 events per hour (p<0.001). The mean respiratory and heart rates were significantly lower 150 min after the administration of chloral hydrate when compared with pre-sedation values (51/min and 127/min versus 61/min and 138/min respectively; p<0.001). A considerable number of patients exhibited changes in cardiorespiratory parameters that differed considerably from the normal ranges. In conclusion, SpO 2 , ETCO 2 , the estimated apnea-hypopnea index and the respiratory and heart rates changed after the administration of chloral hydrate. They remained within normal limits in most newborns, but the inter-individual variability was high in the studied population.

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Use of chloral hydrate as a sedative for auditory brainstem response testing in a pediatric population

Cited by 50 publications

References 23 publications

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

Intranasal dexmedetomidine following failed chloral hydrate sedation in children

Cardiorespiratory parameters in newborns during sedation with chloral hydrate

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