Effect of Chloral Hydrate Sedation on Intraocular Pressure in a Pediatric Population
Varshini Varadaraj1, Beatriz Munoz1, Mohammed Karaoui2
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Oral chloral hydrate (CH) sedation for pediatric eye exams does not affect intraocular pressure (IOP). This study found no significant changes in IOP in children receiving CH for ophthalmic procedures.
Area of Science:
- Ophthalmology
- Pediatric Sedation
- Anesthesiology
Background:
- Intraocular pressure (IOP) is a critical parameter in pediatric eye care.
- Sedation is often required for ophthalmic procedures in young children.
- The effect of common sedatives on IOP needs to be well-understood.
Purpose of the Study:
- To investigate the impact of oral chloral hydrate (CH) sedation on intraocular pressure (IOP).
- To assess IOP changes in pediatric outpatients undergoing ophthalmic evaluations.
- To determine the safety of CH sedation regarding IOP in children.
Main Methods:
- A prospective, noncomparative case series design was employed.
- 112 children aged 1 month to 5 years received oral chloral hydrate for ocular imaging/evaluation.
- Intraocular pressure was measured using an Icare tonometer at various time points before and after sedation.
Main Results:
- Mean intraocular pressure showed a non-significant decline from 19.5 mm Hg pre-sedation to 18.7 mm Hg at 25 minutes post-sedation (P = .12).
- No significant trend of further IOP decline was observed over time.
- Chloral hydrate sedation was deemed adequate in 97.3% of cases, with minimal adverse effects on vital signs.
Conclusions:
- Oral chloral hydrate sedation, as administered in this study, does not significantly impact intraocular pressure in pediatric outpatients.
- CH sedation appears to be a safe option for ophthalmic procedures in children concerning IOP.
- Further research could explore IOP effects with different sedative agents or dosages.
Purpose:
To determine the effect of oral chloral hydrate (CH) sedation on intraocular pressure (IOP) in an outpatient pediatric population.
Design:
Prospective, noncomparative case series.
Methods:
Children aged 1 month to 5 years undergoing CH sedation for ocular imaging/evaluation at a tertiary eye hospital were included. IOP was measured using an Icare tonometer prior to sedation (in some, not all), at 25 minutes after sedation, and then every 10 minutes until sedation completion. Change in IOP over time was assessed using mixed model linear regression to account for correlation of IOP readings.
Results:
A total of 112 children were enrolled, 50.9% were female, and mean age was 2.1 (standard deviation [SD]: 1.3) years. Of the total, 83 (74.1%) participants had IOP measurement attempted prior to sedation, with 64 having presedation IOP completed. Among those completing presedation IOP, 46.9% were asleep/calm, and the rest (53.1%) were slightly/more distressed (IOP did not differ by level of agitation). Those with and without presedation IOP available had similar demographics and health status (P > .05). Heart rate, respiratory rate, and oxygen saturation all declined after sedation (P < .001). The mean dose of CH administered was 80.9 (SD: 13.2) mg/kg, and sedation was deemed "adequate" in 97.3% after a single dose. Mean IOP among those with presedation IOP was 19.5 mm Hg and, although not significant, declined to 18.7 mm Hg at 25 minutes (P = .12). There was no trend toward further decline in IOP over time (P > .05).
Conclusions:
CH sedation for outpatient pediatric ophthalmic procedures as administered in this prospective assessment had no impact on IOP.
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