Safe pediatric outpatient sedation: the chloral hydrate debate revisited

Diagnostic imaging in the pediatric patient frequently requires sedation. The use of chloral hydrate, the standard agent for many years, has recently come under severe scrutiny. The American Academy of Pediatrics (AAP) published guidelines for the elective sedation of pediatric patients; however, compliance with the AAP guidelines is not compulsory. A review of the medical literature shows a wide range of medications used for pediatric sedation, along with a diversity in the protocols available for monitoring the cardiopulmonary status of the patient. When ordering computed tomography and magnetic resonance imaging scans, pediatric otolaryngologists indirectly are exposing their patients to the sedation practices and monitoring protocols of their referral imaging center. A questionnaire regarding the sedation protocol for routine, outpatient, computed tomography or magnetic resonance imaging scans in children aged 5 years or younger was sent to staff radiologists at 36 pediatric medical centers throughout the United States. A variety of sedation practices were elicited. The complete survey results are presented, including monitoring practices, complication, and success rates. Despite concerns about its safety, chloral hydrate remains a frequently used and safe method of pediatric outpatient sedation.