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Updated: Jan 28, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Comparison of chloral hydrate and pentobarbital sedation for pediatric echocardiography
Madhusudan Ganigara1, Shubhika Srivastava2, Preeti Malik1
1Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Chloral hydrate and pentobarbital are equally effective for pediatric conscious sedation during transthoracic echocardiography. Pentobarbital showed fewer respiratory issues, while chloral hydrate had fewer paradoxical reactions, with age predicting sedation success.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Sedation Management
Background:
- Limited outpatient use of chloral hydrate (CH) in 2013 prompted exploration of alternatives like oral pentobarbital (PB) for conscious sedation in pediatric transthoracic echocardiography (TTE).
- Assessing the efficacy and safety of CH versus PB is crucial for optimizing procedural sedation in young children.
Purpose of the Study:
- To compare the effectiveness and safety of chloral hydrate and pentobarbital for conscious sedation in pediatric patients undergoing TTE.
- To identify predictors of sedation success and adverse events in young children receiving CH or PB.
Main Methods:
- A retrospective review of clinical data from children sedated with CH or PB for TTE between 2008 and 2015.
- Comparison of sedation effectiveness (failure rate, need for supplemental doses) and complication rates between the CH and PB groups.
Main Results:
- No significant differences in sedation failure rates (CH 2.4% vs. PB 2.9%) or overall adverse events (CH 1.9% vs. PB 1.4%) were observed.
- Pentobarbital was associated with fewer episodes of respiratory depression (0.3% vs. 1.6% for CH), while chloral hydrate had fewer paradoxical reactions (0.03% vs. 1% for PB).
- Increasing age was a predictor for supplemental sedation doses and sedation failure in both groups; neonates and infants receiving CH showed higher rates of adverse reactions.
Conclusions:
- Chloral hydrate and pentobarbital demonstrate comparable efficacy for pediatric TTE sedation.
- Chloral hydrate is linked to increased transient desaturation, whereas pentobarbital is associated with a higher incidence of paradoxical reactions.
- Patient age is a significant factor influencing the need for additional sedation and the likelihood of sedation failure.
Background:
In 2013, outpatient use of chloral hydrate (CH) was limited and other alternatives such as oral pentobarbital (PB) were explored to achieve conscious sedation in young children for transthoracic echocardiography (TTE). We aimed to assess efficacy and safety of the two medications.
Methods:
Clinical information, from a computerized database, about children who received sedation with either CH or PB for TTE at our center (2008-2015) was reviewed, and the two groups were compared for sedation effectiveness and complications.
Results:
Three thousand eight hundred fifty one pediatric patients (median age 8 months) underwent conscious sedation during TTE (mean doses CH 50 mg/kg, PB 4 mg/kg). Demographic characteristics of the two groups were similar. Sedation failure rate (CH 2.4%, PB 2.9%, P = NS), need for supplemental doses (CH 17.9%, PB 16.2%, P = NS), and overall adverse event rate (PB 1.4%, CH 1.9%; P = NS) were similar in the two groups. There were fewer episodes of respiratory depression with PB (0.3% vs 1.6%, P < 0.05). The rate of paradoxical reactions was higher with PB (1% vs 0.03%, P < 0.05). Increasing age predicted the need for supplemental doses and for sedation failure in both groups. Neonates (7.5% vs 0%) and infants (2% vs 0.6%) given CH were more likely to develop adverse reactions.
Conclusion:
Chloral hydrate and PB are equally effective. However, CH is associated with an increased incidence of transient desaturation, while PB is associated with an increased incidence of a paradoxical reaction. Increasing age is predictive of the need for supplemental doses and for failure of sedation in both groups.
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