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Chloral hydrate for emergent pediatric procedural sedation: a new look at an old drug
1Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso 79905.
Insights
Chloral hydrate demonstrates safety and effectiveness for pediatric procedural sedation in the emergency department (ED), particularly for children under six years old. This study supports its use for improving procedural cooperation in young patients.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Trials
Background:
- Chloral hydrate is a traditional agent for pediatric procedural sedation.
- Its efficacy in emergency department (ED) settings for children remains largely undocumented.
- This study investigates chloral hydrate's utility in the ED environment.
Purpose of the Study:
- To evaluate the safety and effectiveness of chloral hydrate for procedural sedation in pediatric patients within an emergency department.
- To compare sedation scores between children receiving chloral hydrate and a control group.
- To analyze age-related efficacy of chloral hydrate sedation.
Main Methods:
- A nonrandomized controlled trial involving 95 children (1-10 years) requiring procedural intervention.
- Exclusion criteria included respiratory depression, somnolence, allergy, trauma, head injury, or abdominal pain.
- Sedation was assessed using a modified four-point scale, with data analyzed via Mann Whitney U test.
Main Results:
- The overall sedation score for the chloral hydrate group was 2.86 versus 2.75 for controls (P=0.63).
- Statistically significant improvements in sedation scores were observed in children younger than 6 years (P<0.0001) and younger than 4 years (P=0.01).
- No adverse drug effects were reported; mean time to sedation was 42.7 minutes and recovery was 42.0 minutes.
Conclusions:
- Chloral hydrate is a safe and effective option for pediatric procedural sedation in the emergency department.
- Its effectiveness is particularly pronounced in younger children (under 6 years).
- Further research may confirm these findings and establish optimal dosing protocols.
Abstract:
Chloral hydrate has been time honored for pediatric procedural sedation, but its efficacy in sedation for emergency department (ED) procedures is unreported. It is hypothesized that chloral hydrate is safe and effective for ED pediatric sedation. Ninety-five consecutive children ranging from 1-10 years and requiring procedural intervention in a municipal teaching hospital ED were included in a nonrandomized controlled trial. Patients with respiratory depression, somnolence, allergy, multisystem trauma, head injury, or abdominal pain were excluded. Forty-two subjects received chloral hydrate 25 to 50 mg/kg orally at physician discretion, and 53 subjects served as controls. Cooperation with procedural completion was rated by the treating physician using the four-point sedation scoring system modified from Moody et al (1 = poor, 4 = excellent). The two groups' sedation scores were compared by the Mann Whitney U test with significance at P less than .05. Age-related subgroups of children were similarly compared. The treatment group achieved sedation score of 2.86, whereas controls had sedation score of 2.75 (P = 0.63, beta error 20% at 0.37 score difference). Subgroup analysis of children less than 6 years old (2.95 experimental versus 2.57 control) and less than 4 years old (3.00 experimental versus 2.32 control) reveals statistically significant differences (P less than .0001 and P = .01, respectively) in favor of higher sedation scores in the chloral hydrate group. Time to sedation was 42.7 minutes, time to recovery was 42.0 minutes, and no adverse drug effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS)