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Use of chloral hydrate as a sedative for auditory brainstem response testing in a pediatric population
Eirini Avlonitou1, Dimitrios G Balatsouras, Eleftherios Margaritis
1ENT Department of Pediatric Hospital Aglaia Kyriakou, Thivon & Levadias Street, GR-11527, Athens, Greece. eavlonitou@hotmail.com
Insights
Chloral hydrate effectively sedates young children for auditory brainstem response tests. While generally safe, monitoring for side effects like vomiting and hyperactivity is recommended, with rare apnea requiring intervention.
Area of Science:
- Pediatric Sedation
- Auditory Neurophysiology
Background:
- Chloral hydrate (CH) is a common oral sedative for pediatric patients undergoing Auditory Brainstem Response (ABR) testing.
- Ensuring adequate sedation is crucial for successful ABR results in infants and young children.
Purpose of the Study:
- To evaluate the effectiveness and safety of chloral hydrate (CH) for sedating pediatric patients during ABR testing.
- To document the incidence and nature of complications associated with CH use in this population.
Main Methods:
- A retrospective study of 1903 children undergoing ABR from 2003-2007, with a focus on 568 infants under 6 months.
- Chloral hydrate (8%) administered at 40 mg/kg, with potential repeat dosing, for sedation.
- Systematic recording of sedation effectiveness and adverse events including vomiting, rash, hyperactivity, respiratory distress, and apnea.
Main Results:
- Sedation was required for 83.6% of children, with 60% of infants under 6 months successfully sedated with CH.
- Common complications included hyperactivity (8%) and vomiting (11.4%).
- Rare but serious complications like apnea (0.2%) were managed effectively, while others resolved without intervention.
Conclusions:
- Chloral hydrate, at doses of 40-80 mg/kg, is a safe and effective sedative for ABR testing in children.
- Successful administration requires appropriate equipment and trained medical personnel.
- Careful monitoring for potential side effects is essential for patient safety.
Objective:
Chloral hydrate (CH) is an oral sedative widely used to sedate infants and young children during auditory brainstem response (ABR) testing. The aim of this study was to record effectiveness, complications and safety of CH as a sedative for ABR.
Methods:
From January of 2003 until December of 2007, 1903 children were tested for ABR, 568 of them being under the age of 6 months. CH (8%) was used for sedation at a dose of 40 mg/kg with a repeat dose, if necessary, for an adequate sedation, in 20-30 min. We recorded the effectiveness of CH as a sedative for ABR examination, as well as all complications related to the use of CH such as vomiting, rash, hyperactivity, respiratory distress and apnea. The statistical method used was the absolute and percentage frequency distribution of the occurrences.
Results:
Sedation with CH was necessary to perform testing in 1591 (83.6%) of the examined children. However, in the population of the examined infants, only 341 (60%) were sedated with CH, because the remaining 227 (40%) fell asleep by themselves. Complications included hyperactivity in 152 children (8%), minor respiratory distress in 10 children (0.4%), vomiting in 217 children (11.4%), apnea in 4 children (0.2%) and rash in 10 children (0.4%). The complications of hyperactivity, vomiting and rash resolved without any medical treatment. The apnea cases were managed effectively by supplying ventilation to the children via a mask in the presence of an anesthesiologist.
Conclusions:
The use of CH at a dose of 40 mg/kg up to 80 mg/kg is safe and effective when administered in a setting with adequate equipment and the presence of well trained personnel.
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