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Clonidine Versus Chloral Hydrate for Recording Sleep EEG in Children
Mahmoud Reza Ashrafi1, Hossein Mohebbi2, Mahmoud Mohamadi1
1Department of Pediatrics , Children's Medical Center ,Pediatrics Center of Excellence , Division of Pediatric Neurology , Growth and Development Research Center ,Tehran University of Medical Sciences, Tehran, Iran.
Insights
Clonidine and chloral hydrate are effective for pediatric electroencephalography (EEG) sedation. Chloral hydrate offers faster recovery from drowsiness, while clonidine shows a higher yield of epileptiform discharges, aiding in seizure diagnosis.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Pediatric electroencephalography (EEG) requires patient cooperation, often necessitating sedation.
- Sedative medications aim to improve efficacy and reduce adverse effects during pediatric EEG.
Purpose of the Study:
- To compare the efficacy and safety of clonidine versus chloral hydrate as premedication for pediatric EEG.
- To evaluate sedative effects, adverse events, and diagnostic yield of EEG.
Main Methods:
- A prospective, randomized, single-blinded, controlled trial involving 198 children (9-156 months).
- Patients were randomly assigned to receive either clonidine (n=100) or chloral hydrate (n=98).
- Sleep onset latency, duration, and post-procedure drowsiness were assessed.
Main Results:
- Sleep onset was significantly longer with clonidine (p <0.0001).
- Drowsiness post-arousal was more frequent with clonidine (58%) than chloral hydrate (26.1%, p = 0.058).
- Generalized epileptiform discharges were significantly higher in the clonidine group (p = 0.006).
Conclusions:
- Both clonidine and chloral hydrate are viable premedications for pediatric EEG.
- Chloral hydrate provides quicker recovery from sedation.
- Clonidine may increase the diagnostic yield for epileptiform abnormalities.
Objective:
One of the difficulties to conduct electroencephalography (EEG) in pediatric patient population is that they are not always cooperative during the procedure. Different medications are used to induce sedation during EEG recording. In order to find a medication with the least adverse effects and high efficacy, the current study aimed at comparing clonidine and chloral hydrate as a premedication prior to EEG recording in pediatric population.
Materials & Methods:
A prospective, randomized, single-blinded, controlled trial was conducted on 198 children (9 to 156 months old) to investigate the sedative and adverse effects of clonidine and chloral hydrate. Patients, partially sleep-deprived the night before, were randomly divided into two groups of clonidine (n=100) and chloral hydrate (n=98) on an alternative day basis.
Results:
The average sleep onset latency was significantly longer in the clonidine group than chloral hydrate group (the Mann-Whitney test, p <0.0001). Sleep duration ranged 15 to 150 minutes and it was not significantly different between the two groups (the Mann-Whitney test, p = 0.2). Drowsiness terminated faster with chloral hydrate than clonidine.Drowsiness after arousal was observed in 58% and 26.1% of patients in the clonidine and chloral hydrate groups, respectively; the difference between the groups was significant (the Mann-Whitney test, p = 0.058). EEG results were reported normal in 77 subjects in the chloral hydrate group (77%) and 69 subjects (69%) in the clonidine group (p = 0.161). Generalized epileptiform discharges were significant in the clonidine group (the Mann-Whitney test, p = 0.006).
Conclusion:
The results of the current study showed that both 5% chloral hydrate (1 mL/kg) and clonidine (4 μg/kg) could be administered as a premedication prior to EEG recording in children, although drowsiness after arousal was higher with clonidine than chloral hydrate. However, the yield of generalized epileptiform discharges in the clonidine group was greater than that of the chloral hydrate group.
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