Chloral Hydrate Sedation in a Dexmedetomidine Era

Area of Science:

• Pediatric Sedation
• Pharmacology
• Health Services Research

Background:

• Commercial liquid chloral hydrate production ceased, leading to a national decline in its use.
• Oral chloral hydrate is still compounded by some pharmacies, maintaining its availability.
• Alternative sedatives are available, yet chloral hydrate use persists in pediatric procedural sedation.

Purpose of the Study:

• To evaluate the institutional utilization of chloral hydrate as a primary procedural sedation agent.
• To assess trends in chloral hydrate use in pediatric patients undergoing procedures.

Main Methods:

• Retrospective study analyzing chloral hydrate administrations from October 2010 to December 2016.
• Data sourced from hospital pharmacy databases and matched with procedure billing data.
• Study conducted across two free-standing children's hospitals.

Main Results:

• 5874 administrations of chloral hydrate for procedural sedation were recorded during the study period.
• Peak usage was observed in 2014 with 1420 orders.
• The majority of sedations (72.4%) were for cardiac studies/procedures.

Conclusions:

• Local utilization of oral chloral hydrate for procedural sedation remains high, contrasting with national trends.
• Recent declines in use may be attributed to a shift towards alternative sedatives, such as intranasal dexmedetomidine, at high-usage sites.
• Continued high utilization highlights the need for ongoing assessment of sedation practices in pediatric care.