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Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine.
Paediatr Anaesth 2016; 26(3):273-9PA

Abstract

BACKGROUND

Chloral hydrate, a commonly used sedative in children during noninvasive diagnostic procedures, is associated with side effects like prolonged sedation, paradoxical excitement, delirium, and unpleasant taste. Dexmedetomidine, a highly selective α-2 agonist, has better pharmacokinetic properties than chloral hydrate. We conducted this prospective, double-blind, randomized controlled trial to evaluate efficacy of intranasal dexmedetomidine with that of a second oral dose of chloral hydrate for rescue sedation during magnetic resonance imaging (MRI) studies in infants.

METHODS

One hundred and fifty infants (age group: 1-6 months), who were not adequately sedated after initial oral dose of 50 mg · kg(-1) chloral hydrate, were randomly divided into three groups with the following protocol for each group. Group C: second oral dose chloral hydrate 25 mg · kg(-1); Group L and Group H: intranasal dexmedetomidine in a dosage of 1 and 2 mcg · kg(-1), respectively. Status of sedation, induction time, time to wake up, vital signs, oxygen saturation, and recovery characteristics were recorded.

RESULTS

Successful rescue sedation in Groups C, L, and H were achieved in 40 (80%), 47 (94%), and 49 (98%) of infants, respectively, on an intention to treat analysis, and the proportion of infants successfully sedated in Group H was more than that of Group L (P ˂ 0.01). There were no significant differences in sedation induction time; however, the time to wake up was significantly shorter in Group L as compared to that in Group C or H (P < 0.01). No significant adverse hemodynamic or hypoxemic effects were observed in the study.

CONCLUSION

Intranasal dexmedetomidine induced satisfactory rescue sedation in 1- to 6-month-old infants during MRI study, and appears to cause sedation in a dose-dependent manner.

Authors+Show Affiliations

Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26714442

Citation

Zhang, Wenhua, et al. "Comparison of Rescue Techniques for Failed Chloral Hydrate Sedation for Magnetic Resonance Imaging Scans--additional Chloral Hydrate Vs Intranasal Dexmedetomidine." Paediatric Anaesthesia, vol. 26, no. 3, 2016, pp. 273-9.
Zhang W, Wang Z, Song X, et al. Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine. Paediatr Anaesth. 2016;26(3):273-9.
Zhang, W., Wang, Z., Song, X., Fan, Y., Tian, H., & Li, B. (2016). Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine. Paediatric Anaesthesia, 26(3), pp. 273-9. doi:10.1111/pan.12824.
Zhang W, et al. Comparison of Rescue Techniques for Failed Chloral Hydrate Sedation for Magnetic Resonance Imaging Scans--additional Chloral Hydrate Vs Intranasal Dexmedetomidine. Paediatr Anaesth. 2016;26(3):273-9. PubMed PMID: 26714442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine. AU - Zhang,Wenhua, AU - Wang,Zixin, AU - Song,Xingrong, AU - Fan,Yanting, AU - Tian,Hang, AU - Li,Bilian, Y1 - 2015/12/30/ PY - 2015/10/30/accepted PY - 2015/12/31/entrez PY - 2015/12/31/pubmed PY - 2016/12/15/medline KW - chloral hydrate KW - deep sedation KW - dexmedetomidine KW - intranasal administration SP - 273 EP - 9 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 26 IS - 3 N2 - BACKGROUND: Chloral hydrate, a commonly used sedative in children during noninvasive diagnostic procedures, is associated with side effects like prolonged sedation, paradoxical excitement, delirium, and unpleasant taste. Dexmedetomidine, a highly selective α-2 agonist, has better pharmacokinetic properties than chloral hydrate. We conducted this prospective, double-blind, randomized controlled trial to evaluate efficacy of intranasal dexmedetomidine with that of a second oral dose of chloral hydrate for rescue sedation during magnetic resonance imaging (MRI) studies in infants. METHODS: One hundred and fifty infants (age group: 1-6 months), who were not adequately sedated after initial oral dose of 50 mg · kg(-1) chloral hydrate, were randomly divided into three groups with the following protocol for each group. Group C: second oral dose chloral hydrate 25 mg · kg(-1); Group L and Group H: intranasal dexmedetomidine in a dosage of 1 and 2 mcg · kg(-1), respectively. Status of sedation, induction time, time to wake up, vital signs, oxygen saturation, and recovery characteristics were recorded. RESULTS: Successful rescue sedation in Groups C, L, and H were achieved in 40 (80%), 47 (94%), and 49 (98%) of infants, respectively, on an intention to treat analysis, and the proportion of infants successfully sedated in Group H was more than that of Group L (P ˂ 0.01). There were no significant differences in sedation induction time; however, the time to wake up was significantly shorter in Group L as compared to that in Group C or H (P < 0.01). No significant adverse hemodynamic or hypoxemic effects were observed in the study. CONCLUSION: Intranasal dexmedetomidine induced satisfactory rescue sedation in 1- to 6-month-old infants during MRI study, and appears to cause sedation in a dose-dependent manner. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/26714442/Comparison_of_rescue_techniques_for_failed_chloral_hydrate_sedation_for_magnetic_resonance_imaging_scans__additional_chloral_hydrate_vs_intranasal_dexmedetomidine_ L2 - https://doi.org/10.1111/pan.12824 DB - PRIME DP - Unbound Medicine ER -