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Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors.
Pediatrics 2006; 117(3):e434-41Ped

Abstract

OBJECTIVE

The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution.

METHODS

We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed.

RESULTS

Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included > or = 20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n = 3 [0.3%]), airway obstruction (n = 15 [1.4%]), hypoxia (n = 65 [5.9%]), hypercarbia (n = 40 of 603 [6.6%]), hypotension with poor perfusion (n = 4 [0.4%]), vomiting (n = 4 [0.4%]), and prolonged sedation (n = 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors.

CONCLUSIONS

Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this pediatric population. The majority of adverse events were minor, and major events were uncommon. Infants who were younger than 6 months were found to be at higher risk for serious adverse events.

Authors+Show Affiliations

Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA. lisa.heistein@childrens.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16481449

Citation

Heistein, Lisa C., et al. "Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors." Pediatrics, vol. 117, no. 3, 2006, pp. e434-41.
Heistein LC, Ramaciotti C, Scott WA, et al. Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors. Pediatrics. 2006;117(3):e434-41.
Heistein, L. C., Ramaciotti, C., Scott, W. A., Coursey, M., Sheeran, P. W., & Lemler, M. S. (2006). Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors. Pediatrics, 117(3), pp. e434-41.
Heistein LC, et al. Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors. Pediatrics. 2006;117(3):e434-41. PubMed PMID: 16481449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors. AU - Heistein,Lisa C, AU - Ramaciotti,Claudio, AU - Scott,William A, AU - Coursey,Melanie, AU - Sheeran,Paul W, AU - Lemler,Matthew S, Y1 - 2006/02/15/ PY - 2006/2/17/pubmed PY - 2006/3/23/medline PY - 2006/2/17/entrez SP - e434 EP - 41 JF - Pediatrics JO - Pediatrics VL - 117 IS - 3 N2 - OBJECTIVE: The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution. METHODS: We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed. RESULTS: Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included > or = 20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n = 3 [0.3%]), airway obstruction (n = 15 [1.4%]), hypoxia (n = 65 [5.9%]), hypercarbia (n = 40 of 603 [6.6%]), hypotension with poor perfusion (n = 4 [0.4%]), vomiting (n = 4 [0.4%]), and prolonged sedation (n = 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors. CONCLUSIONS: Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this pediatric population. The majority of adverse events were minor, and major events were uncommon. Infants who were younger than 6 months were found to be at higher risk for serious adverse events. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/16481449/Chloral_hydrate_sedation_for_pediatric_echocardiography:_physiologic_responses_adverse_events_and_risk_factors_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=16481449 DB - PRIME DP - Unbound Medicine ER -