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Optimal Initial Dose of Chloral Hydrate in Management of Pediatric Facial Laceration

  • Koo, Su Han (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Lee, Dong Gwan (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Shin, Heakyeong (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine)
  • Received : 2013.05.31
  • Accepted : 2013.07.31
  • Published : 2014.01.15

Abstract

Background Chloral hydrate (CH) is the primary agent most commonly used for pediatric sedation prior to diagnostic, therapeutic procedures. In the management of pediatric facial laceration, the initial dose of CH has to balance the need for adequate sedation against the need to minimize sedative complications. Methods A retrospective review of medical records of 834 children who visited our emergency room for facial lacerations from August 2010 to September 2012 was conducted. They were divided into six groups on the basis of the initial dose of CH administered. Further, each group was compared with the standard group (70 to ${\leq}80mg/kg$) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay. Results With respect to the complication rate, only group 1 (range, 40 to ${\leq}50mg/kg$) showed a significantly lower complication rate. In the case of all the other variables considered, there were no significant differences among any of the groups. Conclusions An initial CH dose of $48{\pm}2mg/kg$ does not negatively affect the success rate of sedation or the need for additional sedative during the primary closure of facial lacerations in pediatric patients. Further, lower doses reduce the incidences of adverse effects and do not delay procedure readiness. Therefore, $48{\pm}2mg/kg$ of CH can be considered the optimal initial dose for pediatric sedation.

Keywords

References

  1. Malis DJ, Burton DM. Safe pediatric outpatient sedation: the chloral hydrate debate revisited. Otolaryngol Head Neck Surg 1997;116:53-7. https://doi.org/10.1016/S0194-5998(97)70352-8
  2. Mace SE, Brown LA, Francis L, et al. Clinical policy: critical issues in the sedation of pediatric patients in the emergency department. Ann Emerg Med 2008;51:378-99.e1-57. https://doi.org/10.1016/j.annemergmed.2007.11.001
  3. World Health Organization. Chloral hydrate [Internet]. Geneva: World Health Organization; 2000 [cited 2013 Nov 22]. Available from: http://www.who.int/ipcs/publications/en/cicad25.pdf.
  4. Goodman LS, Gilman A. The pharmacological basis of therapeutics. 7th ed. New York: Macmillan USA; 1985.
  5. Dalal PG, Murray D, Cox T, et al. Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacologic considerations. Anesth Analg 2006;103:863-8. https://doi.org/10.1213/01.ane.0000237311.15294.0e
  6. Wheeler DS, Jensen RA, Poss WB. A randomized, blinded comparison of chloral hydrate and midazolam sedation in children undergoing echocardiography. Clin Pediatr (Phila) 2001;40:381-7. https://doi.org/10.1177/000992280104000704
  7. Malviya S, Voepel-Lewis T, Tait AR, et al. Pentobarbital vs chloral hydrate for sedation of children undergoing MRI: efficacy and recovery characteristics. Paediatr Anaesth 2004; 14:589-95. https://doi.org/10.1111/j.1460-9592.2004.01243.x
  8. Bracken J, Heaslip I, Ryan S. Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol 2012;42:349-54. https://doi.org/10.1007/s00247-011-2279-9
  9. da Costa LR, da Costa PS, Lima AR. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Braz Dent J 2007; 18:334-40. https://doi.org/10.1590/S0103-64402007000400012
  10. Marti-Bonmati L, Ronchera-Oms CL, Casillas C, et al. Randomised double-blind clinical trial of intermediate- versus high-dose chloral hydrate for neuroimaging of children. Neuroradiology 1995;37:687-91. https://doi.org/10.1007/BF00593395
  11. D'Agostino J, Terndrup TE. Chloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial. Pediatr Emerg Care 2000;16:1-4. https://doi.org/10.1097/00006565-200002000-00001
  12. Keidan I, Gozal D, Minuskin T, et al. The effect of fasting practice on sedation with chloral hydrate. Pediatr Emerg Care 2004;20:805-7. https://doi.org/10.1097/01.pec.0000148027.53598.b8
  13. Coskun S, Yuksel H, Onag A. Chloralhydrate in children undergoing echocardiography. Indian J Pediatr 2001;68:319-22. https://doi.org/10.1007/BF02721836
  14. Ronchera-Oms CL, Casillas C, Marti-Bonmati L, et al. Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging. J Clin Pharm Ther 1994;19:239-43. https://doi.org/10.1111/j.1365-2710.1994.tb00680.x
  15. Greenberg SB, Faerber EN, Aspinall CL, et al. High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age. AJR Am J Roentgenol 1993;161:639-41. https://doi.org/10.2214/ajr.161.3.8352124
  16. Pereira JK, Burrows PE, Richards HM, et al. Comparison of sedation regimens for pediatric outpatient CT. Pediatr Radiol 1993;23:341-4. https://doi.org/10.1007/BF02011952
  17. Malviya S, Voepel-Lewis T, Eldevik OP, et al. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000;84:743-8. https://doi.org/10.1093/oxfordjournals.bja.a013586
  18. Cote CJ, Notterman DA, Karl HW, et al. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000;105:805-14. https://doi.org/10.1542/peds.105.4.805
  19. Malviya S, Voepel-Lewis T, Prochaska G, et al. Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics 2000;105:E42. https://doi.org/10.1542/peds.105.3.e42
  20. Lipshitz M, Marino BL, Sanders ST. Chloral hydrate side effects in young children: causes and management. Heart Lung 1993;22:408-14.

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