Skip to main content
SpringerLink
Log in

Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis

  • Original Research Article
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

Background

Although chloral hydrate has been used as a sedative for more than 100 years, dozens of studies have reported that it has inconsistent sedative effects and high sedation failure rates with initial dose. The high failure rates may lead to repeated administration of sedatives, guardians’ dissatisfaction, parental anxiety, increasing medical workload as well as leading to an increase of adverse events. Our aim is to identify the risk factors associated with chloral hydrate sedative failure with initial dose in children undergoing noninvasive diagnostic procedures.

Methods

Pediatric patients who underwent chloral hydrate sedation for noninvasive diagnostic procedures at our institution between 1 December 2019 and 1 January 2021 were retrospectively analyzed. Data collected included patients’ age, gender, weight, sedation history, sedation failure history, type of procedures, initial dose of choral hydrate, sleep deprivation, sedation failure with initial dose, and sedative duration. The initial dose was classified into three levels: reduced dose (< 40 mg/kg), standard dose (40–60 mg/kg), and high dose (> 60 mg/kg). The patients were divided into three cohorts according to the different initial doses.

Results

A total of 15,922 patients were included in the analysis; 1928 (12.1%) were not well-sedated after administering the initial dose of chloral hydrate. The highest sedative failure was observed in the reduced dose group. By multivariate regression, we identified that heavier weight, patients with a history of sedation or a history of sedation failure, and patients who received magnetic resonance imaging (MRI) or more than one procedure simultaneously were associated with an increased odds of sedation failure at the initial dose. However, outpatients, patients undergoing hearing screening, and patients with sleep deprivation were favored regarding chloral hydrate sedative success.

Conclusion

An alternative drug or drug combination is necessary in patients with heavier weight, those with a sedation history or sedation failure history, and those undergoing an MRI or more than one procedure simultaneously, whereas chloral hydrate is an appropriate sedation option for outpatients, patients undergoing hearing screening, and those with sleep deprivation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zhang Q, Li H, Dong X, Tu W. Short-term effects of single-dose chloral hydrate on neonatal auditory perception: an auditory event-related potential study. PLoS One. 2019;14: e0212195.

    Article  CAS  Google Scholar 

  2. Delgado J, Toro R, Rascovsky S, Arango A, Angel GJ, Calvo V, et al. Chloral hydrate in pediatric magnetic resonance imaging: evaluation of a 10-year sedation experience administered by radiologists. Pediatr Radiol. 2015;45:108–14.

    Article  Google Scholar 

  3. Joo EY, Kim YJ, Park YS, Park J, Song MH, Hahm KD, et al. Intramuscular dexmedetomidine and oral chloral hydrate for pediatric sedation for electroencephalography: a propensity score-matched analysis. Paediatr Anaesth. 2020;30:584–91. https://doi.org/10.1111/pan.13844.

    Article  PubMed  Google Scholar 

  4. Khoza-Shangase K. Current sedation practices in paediatric audiology clinics in Gauteng, South Africa. Int J Pediatr Otorhinolaryngol. 2019;122:93–8. https://doi.org/10.1016/j.ijporl.2019.04.007.

    Article  PubMed  Google Scholar 

  5. Sahyoun C, Cantais A, Gervaix A, Bressan S, Löllgen R, Krauss B. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. Eur J Pediatr. 2021. https://doi.org/10.1007/s00431-021-03930-6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. National Institute for Health and Clinical Excellence (NICE) guidelines. http://www.baos.org.uk/resources/NiceClinicalGuidanceSummaryonSedation.pdf. Accessed March 20, 2017.

  7. West SK, Griffiths B, Shariff Y, Stephens D, Mireskandari K. Utilisation of an outpatient sedation unit in paediatric ophthalmology: safety and effectiveness of chloral hydrate in 1509 sedation episodes. Br J Ophthalmol. 2013;97:1437–42. https://doi.org/10.1136/bjophthalmol-2013-303818.

    Article  PubMed  Google Scholar 

  8. Anderson J, Dalabih S, Birisi E, Dalabih A. Is orally administered pentobarbital a safe and effective alternative to chloral hydrate for pediatric procedural sedation? J Pediatr Pharmacol Ther. 2018;23:460–5. https://doi.org/10.5863/1551-6776-23.6.460.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Miller J, Xue B, Hossain M, Zhang MZ, Loepke A, Kurth D. Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. Paediatr Anaesth. 2016;26:266–72. https://doi.org/10.1111/pan.12819.

    Article  PubMed  Google Scholar 

  10. Bracken J, Heaslip I, Ryan S. Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol. 2012;42:349–54. https://doi.org/10.1007/s00247-011-2279-9.

    Article  PubMed  Google Scholar 

  11. Lee YJ, Kim DK, Kwak YH, Kim HB, Park JH, Jung JH. Analysis of the appropriate age and weight for pediatric patient sedation for magnetic resonance imaging. Am J Emerg Med. 2012;30(7):1189–95. https://doi.org/10.1016/j.ajem.2012.01.009.

    Article  PubMed  Google Scholar 

  12. West SK, Griffiths B, Shariff Y, Stephens D, Mireskandari K. Utilisation of an outpatient sedation unit in paediatric ophthalmology: safety and effectiveness of chloral hydrate in 1509 sedation episodes. Br J Ophthalmol. 2013;97(11):1437–42. https://doi.org/10.1136/bjophthalmol-2013-303818.

    Article  PubMed  Google Scholar 

  13. Seo JS, Kim DK, Kang Y, Kyong YY, Kim JJ, Ahn JY, et al. Current practices for paediatric procedural sedation and analgesia in emergency departments: results of a nationwide survey in Korea. Emerg Med J. 2013;30: e24. https://doi.org/10.1136/emermed-2011-200997.

    Article  PubMed  Google Scholar 

  14. Reynolds J, Rogers A, Medellin E, Guzman JA, Watcha MF. A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing. Paediatr Anaesth. 2016;26:286–93. https://doi.org/10.1111/pan.12854.

    Article  PubMed  Google Scholar 

  15. Jung SM. Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging. Yeungnam Univ J Med. 2020;37:159–68. https://doi.org/10.12701/yujm.2020.00171.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Gumus H, Bayram AK, Poyrazoglu HG, et al. Comparison of effects of different dexmedetomidine and chloral hydrate doses used in sedation on electroencephalography in pediatric patients. J Child Neurol. 2015;30:983–8. https://doi.org/10.1177/0883073814549582.

    Article  PubMed  Google Scholar 

  17. Greenberg SB, Faerber EN, Aspinall CL, Adams RC. High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age. AJR Am J Roentgenol. 1993;161:639–41.

    Article  CAS  Google Scholar 

  18. Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006;367(9512):766–80. https://doi.org/10.1016/S0140-6736(06)68230-5.

    Article  CAS  PubMed  Google Scholar 

  19. Karaoui M, Varadaraj V, Munoz B, Collins ME, Ali Aljasim L, Al Naji E, et al. Chloral hydrate administered by a dedicated sedation service can be used safely and effectively for pediatric ophthalmic examination. Am J Ophthalmol. 2018;192:39–46. https://doi.org/10.1016/j.ajo.2018.05.003.

    Article  CAS  PubMed  Google Scholar 

  20. Jackson TJ, Dawes D, Ahmad S, Martin D, Gyamtso C. Dexmedetomidine improves success of paediatric MRI sedation. Arch Dis Child. 2022. https://doi.org/10.1136/archdischild-2021-322734.

    Article  PubMed  Google Scholar 

  21. Wroblewska-Seniuk KE, Dabrowski P, Szyfter W, Mazela J. Universal newborn hearing screening: methods and results, obstacles, and benefits. Pediatr Res. 2017;81:415–22. https://doi.org/10.1038/pr.2016.250.

    Article  PubMed  Google Scholar 

  22. Yang F, Liu Y, Yu Q, Li S, Zhang J, Sun M, et al. Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine. Paediatr Anaesth. 2019;29:85–91. https://doi.org/10.1111/pan.13526.

    Article  CAS  PubMed  Google Scholar 

  23. Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70 mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3,132 cases. Rev Esp Anestesiol Reanim (Engl Ed). 2021. https://doi.org/10.1016/j.redar.2021.03.008.

    Article  Google Scholar 

  24. Cui Y, Guo L, Mu Q, Cheng Q, Kang L, He Y, et al. Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients. PLoS One. 2021;16: e0245338. https://doi.org/10.1371/journal.pone.0245338.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Valenzuela DG, Kumar DS, Atkins CL, Beers A, Kozak FK, Chadha NK. Chloral hydrate sedation for auditory brainstem response (ABR) testing in children: safety and effectiveness. Int J Pediatr Otorhinolaryngol. 2016;83:175–8. https://doi.org/10.1016/j.ijporl.2016.02.006.

    Article  PubMed  Google Scholar 

  26. Shields CH, Johnson S, Knoll J, Chess C, Goldberg D, Creamer K. Sleep deprivation for pediatric sedated procedures: not worth the effort. Pediatrics. 2004;113(5):1204–8. https://doi.org/10.1542/peds.113.5.1204.

    Article  PubMed  Google Scholar 

  27. Ke P, Zheng C, Liu F, Wu L, Tang Y, Wu Y, Lv D, Chen H, Qian L, Wu X, Zeng K. Relationship between circadian genes and memory impairment caused by sleep deprivation. PeerJ. 2022;10: e13165. https://doi.org/10.7717/peerj.13165.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ong HT, Lim KJ, Low PC, Low PS. Simple instructions for partial sleep deprivation prior to pediatric EEG reduces the need for sedation. Clin Neurophysiol. 2004;115:951–5. https://doi.org/10.1016/j.clinph.2003.11.012.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Yu Cui and Langtao Guo contributed equally on this research.

Authors and Affiliations

  1. Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, No.1617, Riyue Avenue, Qingyang District, Chengdu, 610091, China

    Yu Cui, Langtao Guo, Qixia Mu, Lu Kang, Qin Chen, Qunying Wu, Yani He & Min Tang

Authors
  1. Yu Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Langtao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qixia Mu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lu Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qunying Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yani He
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Min Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu Cui.

Ethics declarations

Funding

All phases of this study were supported by the Health Commission of Sichuan Province (No. 21PJ131) and the Yingcai Scheme of Chengdu Women's and Children's Central Hospital (YC2021006).

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Ethical approval

Ethic approval was obtained from our institution (No. B202104).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Registration number

The study was registered at http://www.chictr.org.cn/listbycreater.aspx (No. ChiCTR2100043578).

Author contributions

Yu Cui contributed to the study conception and design, contributed to the analysis and interpretation of data, drafted the initial manuscript, and reviewed and revised the manuscript. Qixia Mu, Lu Kang, Qin Chen, Qunying Wu, Yani He, and Min Tang helped collect data. Langtao Guo designed the data collection instruments, revised the manuscript, and gave final approval of the version to be published.

Supplementary Information

Below is the link to the electronic supplementary material.

Supporting information 1: The algorithm of diagnostic procedural sedation. (PDF 90 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cui, Y., Guo, L., Mu, Q. et al. Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis. Pediatr Drugs 24, 403–412 (2022). https://doi.org/10.1007/s40272-022-00511-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40272-022-00511-4

Search

Navigation