Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Safety of chloral hydrate sedation in dental practice for children: an overview

  • Song, Sol (Department of Pediatric Dentistry, College of Dentistry, Dankook University) ;
  • Han, Miran (Department of Pediatric Dentistry, Jukjeon Dental Hospital, College of Dentistry, Dankook University) ;
  • Kim, Jongbin (Department of Pediatric Dentistry, College of Dentistry, Dankook University)
  • Received : 2020.04.17
  • Accepted : 2020.06.14
  • Published : 2020.06.30
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Abstract

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords "dental sedation," "chloral hydrate," and "children or adolescent," 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

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References

  1. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007; 17: 391-406. https://doi.org/10.1111/j.1365-263X.2007.00872.x
  2. Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dent Health 1996; 13: 86-92.
  3. Korean Academy of Pediatric Dentistry. Textbook of Pediatric Dentistry. 5th ed. Seoul, Yenang INC. 2014, pp 225-59.
  4. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr Dent 2019; 41: 26E-52E.
  5. Wilson S, Houpt M. Project USAP 2010: Use of sedative agents in pediatric dentistry-a 25-year follow-up survey. Pediatr Dent 2016; 38: 127-33.
  6. Yang YM, Shin TJ, Yoo SH, Choi SC, Kim JY, Jeong TS. Survey of sedation practices by pediatric dentists. J Korean Acad Pediatr Dent 2014; 41: 257-65.
  7. Bae CH, Kim H, Cho KA, Kim MS, Seo KS, Kim HJ. A survey of sedation practices in the korean dentistry. J Korean Dent Soc Anesthesiol 2014; 14: 29-39. https://doi.org/10.17245/jkdsa.2014.14.1.29
  8. Grissinger M. Chloral hydrate: is it still being used? Are there safer alternatives? P T 2019; 44: 444-5, 459.
  9. Abdulhamid I, Tremblay M, Stenger J, Tutag Lehr V. Chloral hydrate for sedation of children with asthma during dental treatment. Eur J Paediatr Dent 2016; 17: 141-6. https://doi.org/10.1007/s40368-016-0225-0
  10. Huang A, Tanbonliong T. Oral sedation postdischarge adverse events in pediatric dental patients. Anesth Prog 2015; 62: 91-9. https://doi.org/10.2344/0003-3006-62.3.91
  11. Nordt SP, Rangan C, Hardmaslani M, Clark RF, Wendler C, Valente M. Pediatric chloral hydrate poisonings and death following outpatient procedural sedation. J Med Toxicol 2014; 10: 219-22. https://doi.org/10.1007/s13181-013-0358-z
  12. McCormack L, Chen JW, Trapp L, Job A. A comparison of sedation-related events for two multiagent oral sedation regimens in pediatric dental patients. Pediatr Dent 2014; 36: 302-8.
  13. Kang J, Vann WF Jr, Lee JY, Anderson JA. The safety of sedation for overweight/obese children in the dental setting. Pediatr Dent 2012; 34: 392-6.
  14. Chicka MC, Dembo JB, Mathu-Muju KR, Nash DA, Bush HM. Adverse events during pediatric dental anesthesia and sedation: a review of closed malpractice insurance claims. Pediatr Dent 2012; 34: 231-8.
  15. Costa LR, Costa PS, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-discharge adverse events following pediatric sedation with high doses of oral medication. J Pediatr 2012; 160: 807-13. https://doi.org/10.1016/j.jpeds.2011.10.025
  16. Kupiec TC, Kemp P, Raj V, Kemp J. A fatality due to an accidental methadone substitution in a dental cocktail. J Anal Toxicol 2011; 35: 512-5. https://doi.org/10.1093/anatox/35.7.512
  17. de Rezende GP, da Costa LR, da Costa PS. The use of chloral hydrate for pediatric dental sedation. Spec Care Dentist 2007; 27: 85-6. https://doi.org/10.1111/j.1754-4505.2007.tb01745.x
  18. Martinez D, Wilson S. Children sedated for dental care: a pilot study of the 24-hour postsedation period. Pediatr Dent 2006; 28: 260-4.
  19. Park M, Kim Y, Jung S, Beak K. Safety and efficacy of submucosal midazolam when combined with oral chloral hydrate, hydroxyzine and nitrous oxide sedation by using Houpt's Scale. J Korean Dent Soc Anesthesiol 2006; 6: 103-12. https://doi.org/10.17245/jkdsa.2006.6.2.103
  20. Myers GR, Maestrello CL, Mourino AP, Best AM. Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation. Pediatr Dent 2004; 26: 37-43.
  21. Lee JH, Park HW. Assessment of vital signs in pediatric dental sedation using chloral hydrate and hydroxyzine. J Korean Acad Pediatr Dent 2002; 29: 155-62.
  22. Leelataweedwud P, Vann WF Jr. Adverse events and outcomes of conscious sedation for pediatric patients: study of an oral sedation regimen. J Am Dent Assoc 2001; 132: 1531-9. https://doi.org/10.14219/jada.archive.2001.0086
  23. Dallman JA, Ignelzi MA Jr, Briskie DM. Comparing the safety, efficacy and recovery of intranasal midazolam vs. oral chloral hydrate and promethazine. Pediatr Dent 2001; 23: 424-30.
  24. Jung JH, Park KT. Evaluation of success rate and temporary hypoxia in pediatric dental sedation using chloral hydrate and hydroxyzine. J Korean Acad Pediatr Dent 2001; 28: 337-44.
  25. Avalos-Arenas V, Moyao-Garcia D, Nava-Ocampo AA, Zayas-Carranza RE, Fragoso-Rios R. Is chloral hydrate/hydroxyzine a good option for paediatric dental outpatient sedation?. Curr Med Res Opin 1998; 14: 219-26. https://doi.org/10.1185/03007999809113362
  26. Engelhart DA, Lavins ES, Hazenstab CB, Sutheimer CA. Unusual death attributed to the combined effects of chloral hydrate, lidocaine, and nitrous oxide. J Anal Toxicol 1998; 22: 246-7. https://doi.org/10.1093/jat/22.3.246
  27. McCann W, Wilson S, Larsen P, Stehle B. The effects of nitrous oxide on behavior and physiological parameters during conscious sedation with a moderate dose of chloral hydrate and hydroxyzine. Pediatr Dent 1996; 18: 35-41.
  28. Needleman HL, Joshi A, Griffith DG. Conscious sedation of pediatric dental patients using chloral hydrate, hydroxyzine, and nitrous oxide--a retrospective study of 382 sedations. Pediatr Dent 1995; 17: 424-31.
  29. Sams DR, Russell CM. Physiologic response and adverse reactions in pediatric dental patients sedated with promethazine and chloral hydrate or meperidine. Pediatr Dent 1993; 15: 422-4.
  30. Wilson S. Conscious sedation and pulse oximetry: false alarms?. Pediatr Dent 1990; 12: 228-32.
  31. Mueller WA, Drummond JN, Pribisco TA, Kaplan RF. Pulse oximetry monitoring of sedated pediatric dental patients. Anesth Prog 1985; 32: 237-40.
  32. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000; 106: 633-44. https://doi.org/10.1542/peds.106.4.633
  33. Ratnapalan S. Chloral hydrate sedation in children. Clin Pediatr (Phila) 2014; 53: 933-6. https://doi.org/10.1177/0009922813508000
  34. American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists. 2016 Oct. Available from http://www.ada.org/-/media/ADA/Education%20and%20Careers/Files/ADA_Sedation_Use_Guidelines.pdf
  35. Wilson S. Oral sedation for dental procedures in children. Berlin Heidelberg. Springer. 2015, pp 46-8.
  36. Mayers DJ, Hindmarsh KW, Sankaran K, Gorecki DK, Kasian GF. Chloral hydrate disposition following single-dose administration to critically ill neonates and children. Dev Pharmacol Ther 1991; 16: 71-7. https://doi.org/10.1159/000480561
  37. The Korean Dental Society of Anesthesiology. Dental Anesthesiology. 3rd ed. Seoul, Koonja. 2015, pp 362-5.
  38. Buck ML. Chloral hydrate use during infancy. Neonatal Pharmacol Q 1992; 1: 31-7.
  39. Malamed S. Sedation: A Guide to Patient Management. 5th ed. Amsterdam, Elsevier. 2009, pp 111.

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