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Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial.
Paediatr Anaesth 2016; 26(3):266-72PA

Abstract

BACKGROUND

Procedural sedation using chloral hydrate is used in many institutions to improve the quality of transthoracic echocardiograms (TTE) in infants and young children. Chloral hydrate has limited availability in some countries, creating the need for alternative effective sedatives.

OBJECTIVE

The aim of our study was to compare the effectiveness of two doses of intranasal dexmedetomidine vs oral chloral hydrate sedation for transthoracic echocardiography.

METHODS

This is a randomized, prospective study of 150 children under the age of 3 years with known or suspected congenital heart disease scheduled for transthoracic echocardiography with sedation. Group CH received oral chloral hydrate 70 mg · kg(-1), group DEX2 received 2 μg · kg(-1) intranasal dexmedetomidine, and group DEX3 received 3 μg · kg(-1) intranasal dexmedetomidine. Acceptance of drug administration, sedation onset and duration, heart rate, and oxygen saturation, sonographer and parent satisfaction were recorded.

RESULTS

All patients were successfully sedated for TTE. A second sedative dose (rescue) for failed single-dose sedation was required for 4% of patients after CH, none of the patients after DEX2, and 4% of patients after DEX3. Patients in group CH had an average heart rate decline of 22% during sedation, while group DEX2 decreased 27%, and group DEX3 23% (P = 0.2180). Mean time from administration of the sedative to final patient discharge was 96 min after CH, 83 min after DEX2, and 94 min after DEX3 (P = 0.1826).

CONCLUSION

Intranasal dexmedetomidine 2 and 3 μg · kg(-1) were found to be as effective for TTE sedation as oral chloral hydrate with similar sedation onset and recovery time and heart rate changes in this study population.

Authors+Show Affiliations

Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.Department of Anesthesiology, Shanghai Children's Hospital Medical Center, Shanghai, China.Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Cincinnati, OH, USA.Department of Anesthesiology, Shanghai Children's Hospital Medical Center, Shanghai, China.Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26616644

Citation

Miller, Jeff, et al. "Comparison of Dexmedetomidine and Chloral Hydrate Sedation for Transthoracic Echocardiography in Infants and Toddlers: a Randomized Clinical Trial." Paediatric Anaesthesia, vol. 26, no. 3, 2016, pp. 266-72.
Miller J, Xue B, Hossain M, et al. Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. Paediatr Anaesth. 2016;26(3):266-72.
Miller, J., Xue, B., Hossain, M., Zhang, M. Z., Loepke, A., & Kurth, D. (2016). Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. Paediatric Anaesthesia, 26(3), pp. 266-72. doi:10.1111/pan.12819.
Miller J, et al. Comparison of Dexmedetomidine and Chloral Hydrate Sedation for Transthoracic Echocardiography in Infants and Toddlers: a Randomized Clinical Trial. Paediatr Anaesth. 2016;26(3):266-72. PubMed PMID: 26616644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. AU - Miller,Jeff, AU - Xue,Bin, AU - Hossain,Md, AU - Zhang,Ma-Zhong, AU - Loepke,Andreas, AU - Kurth,Dean, Y1 - 2015/11/30/ PY - 2015/10/12/accepted PY - 2015/12/1/entrez PY - 2015/12/1/pubmed PY - 2016/12/15/medline KW - child KW - congenital heart disease KW - induction of anesthesia KW - infant KW - pharmacodynamics KW - premedications SP - 266 EP - 72 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 26 IS - 3 N2 - BACKGROUND: Procedural sedation using chloral hydrate is used in many institutions to improve the quality of transthoracic echocardiograms (TTE) in infants and young children. Chloral hydrate has limited availability in some countries, creating the need for alternative effective sedatives. OBJECTIVE: The aim of our study was to compare the effectiveness of two doses of intranasal dexmedetomidine vs oral chloral hydrate sedation for transthoracic echocardiography. METHODS: This is a randomized, prospective study of 150 children under the age of 3 years with known or suspected congenital heart disease scheduled for transthoracic echocardiography with sedation. Group CH received oral chloral hydrate 70 mg · kg(-1), group DEX2 received 2 μg · kg(-1) intranasal dexmedetomidine, and group DEX3 received 3 μg · kg(-1) intranasal dexmedetomidine. Acceptance of drug administration, sedation onset and duration, heart rate, and oxygen saturation, sonographer and parent satisfaction were recorded. RESULTS: All patients were successfully sedated for TTE. A second sedative dose (rescue) for failed single-dose sedation was required for 4% of patients after CH, none of the patients after DEX2, and 4% of patients after DEX3. Patients in group CH had an average heart rate decline of 22% during sedation, while group DEX2 decreased 27%, and group DEX3 23% (P = 0.2180). Mean time from administration of the sedative to final patient discharge was 96 min after CH, 83 min after DEX2, and 94 min after DEX3 (P = 0.1826). CONCLUSION: Intranasal dexmedetomidine 2 and 3 μg · kg(-1) were found to be as effective for TTE sedation as oral chloral hydrate with similar sedation onset and recovery time and heart rate changes in this study population. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/26616644/Comparison_of_dexmedetomidine_and_chloral_hydrate_sedation_for_transthoracic_echocardiography_in_infants_and_toddlers:_a_randomized_clinical_trial_ L2 - https://doi.org/10.1111/pan.12819 DB - PRIME DP - Unbound Medicine ER -