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DOI: 10.5999/aps.2014.41.1.40
Optimal Initial Dose of Chloral Hydrate in Management of Pediatric Facial Laceration
Authors
BackgroundChloral 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.
MethodsA 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 ≤80 mg/kg) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay.
ResultsWith respect to the complication rate, only group 1 (range, 40 to ≤50 mg/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.
ConclusionsAn initial CH dose of 48±2 mg/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±2 mg/kg of CH can be considered the optimal initial dose for pediatric sedation.
Publication History
Received: 31 May 2013
Accepted: 31 July 2013
Article published online:
02 May 2022
© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Malis DJ, Burton DM. Safe pediatric outpatient sedation: the chloral hydrate debate revisited. Otolaryngol Head Neck Surg 1997; 116: 53-57
- 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: 378-399 e1-e57
- 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: 863-868
- 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: 381-387
- 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: 589-595
- 8 Bracken J, Heaslip I, Ryan S. Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol 2012; 42: 349-354
- 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: 334-340
- 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: 687-691
- 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
- 12 Keidan I, Gozal D, Minuskin T. et al. The effect of fasting practice on sedation with chloral hydrate. Pediatr Emerg Care 2004; 20: 805-807
- 13 Coskun S, Yuksel H, Onag A. Chloralhydrate in children undergoing echocardiography. Indian J Pediatr 2001; 68: 319-322
- 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: 239-243
- 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: 639-641
- 16 Pereira JK, Burrows PE, Richards HM. et al. Comparison of sedation regimens for pediatric outpatient CT. Pediatr Radiol 1993; 23: 341-344
- 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: 743-748
- 18 Cote CJ, Notterman DA, Karl HW. et al. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105: 805-814
- 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
- 20 Lipshitz M, Marino BL, Sanders ST. Chloral hydrate side effects in young children: causes and management. Heart Lung 1993; 22: 408-414