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Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging
C L Ronchera-Oms1, C Casillas, L Martí-Bonmatí
1School of Pharmacy, Colegio Universitario CEU San Pablo, University of Valencia, Moncada, Spain.
Insights
Oral chloral hydrate is effective for pediatric Magnetic Resonance imaging (MRI) sedation, achieving 94.1% success. Factors like age and dose influence sedation effectiveness, with adverse reactions occurring in 9.9% of cases.
Area of Science:
- Pediatric imaging
- Pharmacology
- Radiology
Background:
- Sedation is crucial for pediatric Magnetic Resonance imaging (MRI).
- Oral chloral hydrate is a common sedative agent.
- Assessing its efficacy in a large pediatric cohort is important.
Purpose of the Study:
- To evaluate the effectiveness of oral chloral hydrate for sedation in pediatric MRI.
- To identify factors influencing sedation success and failure.
- To document adverse events associated with chloral hydrate.
Main Methods:
- A prospective, open-label study involving 596 pediatric patients undergoing MRI.
- Administration of oral chloral hydrate syrup at 70 mg/ml, 20-40 minutes prior to the procedure.
- Statistical analysis to compare successful and failed sedation based on dose, age, and weight.
Main Results:
- Effective sedation was achieved in 94.1% of patients.
- Sedation failures were significantly associated with lower doses, older age, and higher weight (P < 0.05).
- Adverse reactions occurred in 9.9% of children, primarily nausea and vomiting.
Conclusions:
- Oral chloral hydrate is a safe and effective sedative for pediatric MRI.
- Age and total administered dose are key predictors of sedation success.
- Further research may optimize dosing strategies for specific pediatric populations.
Abstract:
Sedation is routinely required for successful Magnetic Resonance imaging in infants and children. Five hundred and ninety-six paediatric patients (270 female and 326 male, age (mean +/- SD) 41 +/- 30 months and weight 14.8 +/- 6.5 kg) entered an open, non-comparative, prospective study to assess oral chloral hydrate sedation in a large and homogeneous paediatric population undergoing Magnetic Resonance imaging. Chloral hydrate syrup 70 mg/ml was administered 20-40 min prior to the procedure. Effective sedation was reached in 94.1% with a total dose (mean +/- SEM) of 68 +/- 1 mg/kg (range 20-170 mg/kg). Statistical analysis of sedation failures vs. successful examinations after the total dose showed significant differences for dose (62 +/- 4 vs. 69 +/- 1 mg/kg; P < 0.05), age (64 +/- 7 vs. 40 +/- 1 months; P < 0.001) and weight (19.8 +/- 1.5 vs. 14.5 +/- 0.0 kg; P < 0.001). Effectiveness fell to around 80% in children with encephalic white matter alterations, medullary tumours or syringohydromyela (P = 0.07). The mean time of onset of sedation was 26 +/- 1 min, and the mean time to spontaneous awakening after the completion of the Magnetic Resonance examination was 38 +/- 2 min. Fifty-nine children (9.9%) experienced adverse reactions, with nausea and vomiting being the most common (n = 41), followed by nervousness and unusual excitement (n = 6). Discriminant function analysis identified age and total dose as the quantitative variables helping to differentiate between sedation failures and satisfactory examinations (sensitivity = 0.73, and specificity = 0.61; r = 0.20, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)