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Chloral hydrate side effects in young children: causes and management
M Lipshitz1, B L Marino, S T Sanders
1Children's Hospital, Boston, MA 02115.
Insights
Chloral hydrate is an effective and safe sedative for pediatric echocardiograms. Factors like nap schedule and food intake influence sedation effectiveness in children.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Nursing
Background:
- Echocardiography requires sedation in young children.
- Chloral hydrate is commonly used for sedation.
- Understanding factors influencing its effects is crucial.
Purpose of the Study:
- Determine factors affecting undesired chloral hydrate effects in pediatric echocardiograms.
- Investigate reactions before sedation, sedation delay, sleep depth, and post-sedation behavior.
Main Methods:
- Descriptive, correlational study in a pediatric teaching hospital.
- 140 children (0-36 months) undergoing echocardiography.
- Data collected: age, food intake, oxygen saturation, nap schedule.
Main Results:
- 18% experienced paradoxical excitement; average sedation time was 25 minutes.
- 94% achieved deep sedation; older children, near naptime, and after fasting slept best.
- Cyanotic defect children tolerated sedation well; most had post-sedation behavioral changes.
Conclusions:
- Chloral hydrate is safe and effective for pediatric echocardiogram sedation.
- Nursing implications: optimize scheduling, limit food intake, and counsel parents.
- Nap proximity and fasting improve sedation depth and duration.
Objective:
To determine the factors related to undesired effects of chloral hydrate in young children undergoing echocardiogram. Undesired effects studied were reaction to chloral hydrate before to sedation (ataxia, excitement), delayed sedation, light sleep during sedation, and behavioral changes after sedation.
Design:
Descriptive, correlational design.
Setting:
Echocardiography laboratory in a pediatric teaching hospital.
Subjects:
140 children aged 0 to 36 months who were undergoing diagnostic echocardiography. Severity of cardiac disease ranged from benign murmur to uncorrectable lesion. Thirty children (21%) had cyanotic cardiac disease. Children were sedated with chloral hydrate per routine (mean dose 87 mg/kg) and observed from time of sedation throughout the examination. Data were collected on child's age, food ingested before sedation, transcutaneous oxygen saturation, and daytime nap schedule.
Outcome Measures:
Incidence of paradoxical excitement before sedation, length of time until child reached deep sedation, depth of sleep during the examination, and behavioral changes after sedation.
Results:
Paradoxical excitement before sedation occurred in 25 children (18%). Length of time until child reached deep sedation averaged 25 minutes. Three children never fell asleep. Proximity of sedation to naptime was positively correlated to the speed of sedation. Deep sedation was achieved in 131 children (94%). Depth of sleep during the examination was related to child's age, proximity of sedation to nap time, and recent food ingestions. Older children, who were due for a nap and who had refrained from eating before the examination were most likely to remain soundly asleep throughout the examination. Children with cyanotic defects were not adversely affected by deep sedation with chloral hydrate. Most children experienced motor and affective changes after sedation.
Conclusions:
In this sample, chloral hydrate was an effective and safe sedative. Implications for nursing include changes in scheduling practices, limiting food ingestion before sedation, and information to provide parents about chloral hydrate sedation.