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A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography
V M Yuen1,2, B L Li3, D K Cheuk4
1Department of Anaesthesiology, Hong Kong Children's Hospital, Hong Kong, China.
Insights
Dexmedetomidine may offer a better sedation option for children undergoing CT scans compared to chloral hydrate, with similar recovery times but less vomiting. This finding aids in selecting effective pediatric sedation methods.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Radiology
Background:
- Chloral hydrate is a common sedative for pediatric procedures.
- Dexmedetomidine offers a shorter half-life, potentially leading to quicker recovery.
- Evaluating alternative sedatives is crucial for optimizing pediatric care.
Purpose of the Study:
- To compare the efficacy and safety of intranasal dexmedetomidine versus chloral hydrate for sedating children during computerized tomography (CT) scans.
- To assess patient comfort, sedation satisfaction, recovery time, and adverse events.
Main Methods:
- A randomized controlled trial involving 196 children undergoing CT scans.
- Children received either chloral hydrate syrup (50 mg/kg) + intranasal saline or placebo syrup + intranasal dexmedetomidine (3 μg/kg) 30 minutes prior to the scan.
- Outcomes included resistance/crying, sedation satisfaction, functional recovery, and vomiting.
Main Results:
- More children resisted or cried after chloral hydrate (67%) compared to placebo (48%), p=0.009. No significant difference in resistance was observed between dexmedetomidine and placebo.
- Sedation satisfaction was similar between chloral hydrate (76%) and dexmedetomidine (74%), p=0.74.
- Vomiting occurred in 6 children after chloral hydrate but none after dexmedetomidine, p=0.03. Functional recovery rates were comparable (39% vs 42%, p=0.76).
Conclusions:
- Intranasal dexmedetomidine may be a preferable alternative to chloral hydrate for pediatric CT sedation due to reduced agitation and vomiting.
- Both agents provide comparable sedation satisfaction and functional recovery.
- Further research into optimal dosing and long-term effects is warranted.
Abstract:
Chloral hydrate is commonly used to sedate children for painless procedures. Children may recover more quickly after sedation with dexmedetomidine, which has a shorter half-life. We randomly allocated 196 children to chloral hydrate syrup 50 mg.kg-1 and intranasal saline spray, or placebo syrup and intranasal dexmedetomidine spray 3 μg.kg-1 , 30 min before computerised tomography studies. More children resisted or cried after drinking chloral hydrate syrup than placebo syrup, 72 of 107 (67%) vs. 42 of 87 (48%), p = 0.009, but there was no difference after intranasal saline vs. dexmedetomidine, 49 of 107 (46%) vs. 40 of 87 (46%), p = 0.98. Sedation was satisfactory in 81 of 107 (76%) children after chloral hydrate and 64 of 87 (74%) children after dexmedetomidine, p = 0.74. Of the 173 children followed up for at least 4 h after discharge, 38 of 97 (39%) had recovered normal function after chloral hydrate and 32 of 76 (42%) after dexmedetomidine, p = 0.76. Six children vomited after chloral hydrate syrup and placebo spray vs. none after placebo syrup and dexmedetomidine spray, p = 0.03.
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