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Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities
Published on: January 29, 2014
A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for
Bi L Li1, Vivian M Yuen2, Jia L Zhou1
1Department of Anaesthesiology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China.
Insights
Intranasal dexmedetomidine plus buccal midazolam offers higher success rates for auditory brainstem response testing sedation compared to chloral hydrate. This combination provides quicker onset and better behavior during administration with similar safety profiles.
Area of Science:
- Pediatric Anesthesiology
- Neurophysiology
- Pharmacology
Background:
- Auditory Brainstem Response (ABR) testing often requires moderate to deep sedation.
- Chloral hydrate is a common sedative, but intranasal dexmedetomidine is emerging for pediatric procedural sedation.
Purpose of the Study:
- To compare the sedation success rate of oral chloral hydrate versus intranasal dexmedetomidine plus buccal midazolam for ABR testing in children.
Main Methods:
- Children undergoing ABR tests were randomized to receive either oral chloral hydrate (50 mg/kg) or intranasal dexmedetomidine (3 μg/kg) with buccal midazolam (0.1 mg/kg).
- The primary outcome was the rate of successful sedation for the ABR test.
Main Results:
- Sedation success was higher with dexmedetomidine/midazolam (89.7%) compared to chloral hydrate (69.5%), with an odds ratio of 3.84.
- The dexmedetomidine/midazolam group had a quicker onset of sedation (15 min vs. 20 min) and better observed behavior during administration.
- Adverse events, including hypotension and bradycardia, were similar between groups, with no need for oxygen therapy or medical intervention.
Conclusions:
- Intranasal dexmedetomidine plus buccal midazolam provides superior sedation success and deeper sedation levels for ABR testing compared to chloral hydrate.
- This combination demonstrates a faster onset and improved patient behavior during administration, with comparable safety profiles and discharge times.
Background:
Moderate to deep sedation is required for an auditory brainstem response test when high-intensity stimulation is used. Chloral hydrate is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric non-painful procedural sedations.
Objective:
The aim of this study was to compare the sedation success rate after oral chloral hydrate at 50 mg kg-1 and intranasal dexmedetomidine at 3 μg kg-1 plus buccal midazolam at 0.1 mg kg-1 for an auditory brainstem response test.
Methods:
Children who required an auditory brainstem response test were recruited and randomly assigned to receive oral chloral hydrate at 50 mg kg-1 and intranasal placebo, or intranasal dexmedetomidine at 3 μg kg-1 with buccal midazolam 0.1 mg kg-1 . The primary outcome was the rate of successful sedation for auditory brainstem response tests.
Results:
Fifty-seven out of 82 (69.5%) were successfully sedated after chloral hydrate, while 70 out of 78 (89.7%) children were successfully sedated with dexmedetomidine plus midazolam combination, with the odd ratio (95% CI) for successful sedation between dexmedetomidine plus midazolam combination and chloral hydrate estimated to be 3.84 (1.61-9.16), P = 0.002. Dexmedetomidine plus midazolam was associated with quicker onset with median onset time 15 (IQR 11.0-19.8) for dexmedetomidine plus midazolam and 20 (IQR 15.0-27.0) for chloral hydrate respectively, with difference between median (95% CI) of 5 [3-8], P < 0.0001). The behavior observed during drug administration of intranasal dexmedetomidine and buccal midazolam was better that of the children who had oral chloral hydrate. No children required oxygen therapy or medical intervention for hemodynamic disturbances in this study and the incidence of hypotension and bradycardia was similar.
Conclusion:
Intranasal dexmedetomidine plus buccal midazolam was associated with higher sedation success with deeper level of sedation, with similar discharge time and adverse event rate when compared to chloral hydrate.
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