PURPOSE: Pediatric sedation is an important factor for obtaining the images of good quality. We performed this study to analyze the efficacy of our sedation protocol using chloral hydrate. MATERIALS AND METHODS: We collected prospectively 151 sedation records of children(1 day-15 years old), who were sedated with chloral hydrate for MR(n=112) or CT(n=39) studies. We initially administered 50mg/Kg orally(n=94) or rectally(n=57) 30 minutes before the scheduled examinations, and then administered additionali dose (second dose :25-35mg/Kg, third dose:10-15mg/Kg) to patients whom initial dose failed to sedate. RESULTS: Satisfactory sedation was achieved by initial administration in 109 patients(72%) without si difference between oral(per oral: P.O.) and rectal(per rectal: P.R.) administration. Second dose was required in 28% and third dose in 5%. MR and CT examinations required second dose in 36(32%) and 6 patients(15%), respectively. P.O. -patients vomited in 5%. P.R. -patients defecated in 22% after initial administration. There were no other serious complications. Time interval from the drug administration to the start of examinations was 33 minutes in initial-dose-group and 64 minutes in additional-dose-group. Two patients could not complete MR examination due to early arousal. Prolonged sedation, requiring more than 30 minutes for alertness after MR and CT examinations, was encountered in twenty(18%) and two patients(5%), respectively. CONCLUSION: Our protocol using chloral hydrate(P.O. or P.R.) is thought to be an effective and safe method for pediatric sedation for MR or CT imaging.
Arousal ; Child* ; Chloral Hydrate* ; Humans ; Prospective Studies

Chloral hydrate, a good hypnotic agent, can be used as a substitute for general anesthesia if the ocular examination is complicated by poor patient cooperation in pediatric ophthalmology. We studied the change of the intraocular pressure in rabbits with rectally administered chloral hydrate. We found that chloral hydrate sedation had no effect on intraocular pressure.
Anesthesia, General ; Chloral Hydrate* ; Intraocular Pressure* ; Ophthalmology ; Patient Compliance ; Rabbits

Eight-two eyes of 41 normal newborn were examined at their second day of life to determine intraocular pressure with Tonopen and horizontal corneal diameter with caliper and Cup/Disc(C/D) ratio with direct ophthalmoscope under chloral hydrate sedation. It was 13.0 +/- 3.4mmHg, 10.0 +/- 0.4 and 0.3 +/- 0.1, respectively. These values will aid the ophthalmologist in the diagnosis and management of congenital glaucoma.
Chloral Hydrate ; Diagnosis ; Glaucoma ; Humans ; Infant, Newborn* ; Intraocular Pressure* ; Ophthalmoscopes

PURPOSE: To compare the sedation outcome according to the dose of per os chloral hydrate in children who underwent laceration repair in the emergency department (ED). METHODS: This retrospective study was performed to the children who underwent sedation using chloral hydrate for laceration repair in the ED from January 2015 through November 2015. A total of 370 children aged younger than 6 years underwent the sedation. We compared the induction time, duration of sedation, and ED length of stay (EDLOS) between the single dose (50 mg/kg) and additional dose (plus 25 mg/kg) groups. RESULTS: Of 370 children, 335 (90.5%) were sedated successfully, 284 (76.8%) were sedated with initial dose (the single dose group), and 51 (13.8%) were sedated with additional dose (the additional dose group). The induction time and EDLOS were longer in the additional dose group (induction time: 31.0 ± 17.2 minutes vs. 96.2 ± 25.4 minutes, P < 0.001; EDLOS: 137.2 ± 35.5 minutes vs. 193.0 ± 36.0 minutes, P < 0.001). The duration of sedation showed no difference between the 2 groups (44.4 ± 24.0 minutes vs. 42.0 ± 20.8 minutes; P = 0.500). No one had serious adverse reactions. CONCLUSION: Additional dose of chloral hydrate can increase the induction time and EDLOS without increasing the duration of sedation and causing serious adverse reactions. This information may improve the efficiency of ED workflow when shared with parents of the children.
Child* ; Chloral Hydrate* ; Conscious Sedation ; Emergency Service, Hospital ; Humans ; Lacerations* ; Length of Stay ; Parents ; Retrospective Studies

BACKGROUND: We aimed to evaluate the efficacy and safety of chloral hydrate-based pediatric sedation conducted by non-anesthesiologists. METHODS: The design and setting of this study was a single-center retrospective study performed at a tertiary university hospital between July 2012 and May 2013. A total of 519 children were enrolled in this study. We investigated the sedation medication, age of patients and type of diagnostic tests or procedures and evaluated the success rate of sedation, sedation/recovery profiles and adverse events. RESULTS: Most patients underwent moderate sedation for diagnostic tests. The most commonly used sedative drug was chloral hydrate, which was solely used for 482 patients. A combination of chloral hydrate/midazolam was used for 24 patients and midazolam only was used for 13 patients. Use of chloral hydrate resulted in a sedation success rate of 65.5% after the initial dose and a success rate of 95.2% with additional doses. The sedation failure rate in children > 6 years was significantly higher than that in children under 6 years. In all patients, the overall onset time and recovery time were too slow and long, respectively, and there was no critical complication. CONCLUSIONS: This study demonstrated that chloral hydrate-based pediatric sedation conducted by non-anesthesiologists was mostly moderate, with a high success rate and a low complication rate. However, the overall onset time and recovery time were too slow and long, respectively. Especially, alternative sedation regimens are required in children > 6 years considering the slower onset time and higher failure rate of sedation.
Child ; Chloral Hydrate ; Conscious Sedation ; Diagnostic Tests, Routine ; Humans ; Midazolam ; Retrospective Studies

PURPOSE: To evaluate the sedative effect of add-on chlorpheniramine in children with neurologic diseases failed to sedate with chloral hydrate and midazolam. METHODS: Thirty three patients who had not been successfully sedated with oral chloral hydrate and intravenous midazolam for diagnostic examinations were attempted for sedation with intravenous chlorpheniramine at Chonnam National University Hospital from September 2007 to September 2012. The sedative effects were compared on the aspects of age, sex, body weight, dosage of drug and underlying neurologic conditions with the retrospective review of medical records. RESULTS: Among 33 patients, 26(78.7%) were successfully sedated and 7(24.2%) failed to sedate. The success rates were different by age and were decreased with age: 100%(0-4y), 84.6%(5-9y), 50%(10-14y). The effectiveness of chlorpheniramine was not significantly different in terms of ages, sex, body weight, dosage of drug and the underlying neurologic conditions-developmental delay, seizures or organic brain lesions. Children with ADHD(attention-deficit hyperactivity disorder), however, showed a significantly lower success rate than the non-ADHD patient group (28.5%, P=0.002). No serious side effects were reported except for one case with transient perioral cyanosis. CONCLUSION: Chlorpheniramine appeared highly effective in children with neurologic diseases who had not been sedated with chloral hydrate and midazolam. The efficacy seemed to be higher in the younger age groups and lower in children with ADHD.
Body Weight ; Brain ; Child ; Chloral Hydrate ; Chlorpheniramine ; Humans ; Hypnotics and Sedatives ; Midazolam ; Retrospective Studies ; Seizures

BACKGROUND: To study the effect of chloral hydrate oral premedication on sedation and arterial oxygen saturation in noncyanotic and cyanotic congenital heart disease children. METHODS: 18 noncyanotic congenital heart disease patients and 18 cyanotic congenital heart disease patients scheduled for cardiac surgery were premedicated orally with chloral hydrate 50 mg/kg. Arterial oxygen saturations were measured with pulse oximeter before and after oral premedication and sedation effects evaluated. RESULTS: In noncyanotic group oxygen saturation decreased from 98.7+/-0.95% (mean+/-?SD) before premedication to 97.8+/-1.15% after premedication with statistical significance but without meaning. 16 of the 18 patients (89%) were adequately sedated without airway obstructions. In cyanotic group oxygen saturation increased with statistical insignificance from 73.5+/-10.9% before premedication to 74.0+/-13.9% after premedication. 15 of the 18 patients(83%) were adequately sedated. Effects on oxygen saturation in cyanotic group patients were quite variable with 3 of the patients revealing more than 10% decrease in oxygen saturation. CONCLUSIONS: Chloral hydrate has a good sedative effects on congenital heart disease children but its effects on oxygen saturation were variable and close monitoring followed by oxygen administration is recommended in cyanotic heart patients.
Airway Obstruction ; Child* ; Chloral Hydrate* ; Heart ; Heart Defects, Congenital* ; Humans ; Hypnotics and Sedatives ; Oxygen* ; Premedication ; Thoracic Surgery

PURPOSE: Sedation is often needed to perform an imaging study or procedure on a child. Although chloral hydrate is the most commonly used drug for pediatric sedation, little data are available for its efficacy or adverse effects. This study was undertaken to evaluate the efficacy of chloral hydrate for sedation and define any problems for using this agent in children. METHODS: The medical records of 324 infants and children, who were admitted at Chonnam National University Hospital from January 2005 to December 2005 were retrospectively reviewed. Age, sex, body weight, underlying diagnosis, performed procedure, dose of chloral hydrate, initial response, delayed response and other additional agents for sedation were reviewed. If the desired level(3 on the Skeie scale) was not reached within 30 min after the administration of drugs, sedation was considered as potentially failed. RESULTS: The average age of the study group was 27 months. Among 324 patients, 107 (33.0%) failed for chloral hydrate sedation. 77(47.8%) of the neurologically impaired 161 patients and 30(18.4%) of the unimpaired 163 patients failed on sedation with chloral hydrate. Among neurologically impaired cases, who had either developmental delay or seizures or both of them, 56.8%(25/44), 50.0%(58/116) and 64.7%(22/34) in each category respectively failed on sedation with chloral hydrate. CONCLUSION: In neurologically impaired patients, sedation by chloral hydrate was so difficult and prone to have adverse effects that it is recommended to supplement another drug than to administer the same drug again. However, further studies on effective methods of sedation are needed.
Body Weight ; Child ; Chloral Hydrate ; Humans ; Infant ; Medical Records ; Retrospective Studies ; Seizures

PURPOSE: Chloral hydrate is a common drug frequently used for procedural sedation. But data on chloral hydrate use in the newborns are limited. This study examined the frequency of adverse effects of chloral hydrate and factors related to the adverse effects. We also examined if there were additional adverse effects when an additional sedative was used. METHODS: The medical records of 104 patients admitted to neonatal intensive care unit of Seoul St. Mary's Hospital from March 2010 to February 2011 who used chloral hydrate for procedural sedation were retrospectively reviewed. RESULTS: Adverse effects after administration of chloral hydrate were noted in 41.3% of the 104 patients. The adverse events included oxygen desaturation (18.8%), increase in apneic episodes (17.5%), increase in bradycardia (10%), and feeding intolerance (3.8%). Using oxygen at the time of chloral hydrate administration was independently associated with adverse effects (odds ratio [OR], 10.911; 95% confidence interval [CI], 2.082-57.178) and with the necessity for an additional sedative after administration of chloral hydrate (OR, 4.151; 95% CI, 1.455-11.840). Using one additional sedative agent after chloral hydrate showed no difference in adverse effects except feeding intolerance. CONCLUSION: Patients dependent on oxygen at the time of chloral hydrate administration may were found to be at higher risk for adverse effect of chloral hydrate and for an additional sedative. When an additional sedative is needed, it could be used with monitoring feeding intolerance after chloral hydrate administration.
Bradycardia ; Chloral Hydrate ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Oxygen ; Retrospective Studies

Chloral hydrate is widely used as a sedative or hypnotic, especially in pediatric patients, but cardiac arrhythmia following chloral hydrate administration has rarely been reported in literature up to date. The most common cardiac arrhythmia is ventricular extrasystole. We describe a 17- year-old Down syndrome patient who developed a life-threatening cardiac arrhythmia developed after chloral hydrate administration of 100mg/kg body weight, which is within the recommended limits of dosage. Children who are given chloral hydrate, even within the recommended dosage, should be carefully observed because of the possibility of cardiac arrhythmia.
Arrhythmias, Cardiac ; Body Weight ; Child ; Chloral Hydrate* ; Down Syndrome ; Eating* ; Humans ; Tachycardia, Ventricular* ; Ventricular Premature Complexes