Research Article
Comparison of Chloral Hydrate and Hydroxyzine in Pediatric Electroencephalogram Recording; Sedation Successes and Changes in Vital Signs
Abstract
During electroencephalogram (EEG) recording of children, sedatives are frequently needed. It’s reported that Chloral hydrate (CH) and Hydroxyzine (H) have negligible negative effect on EEG and are safe. The effect of CH and H on vital signs has not been studied in detail previously. We compared the sedation success, side effects, and effects on vital signs of CH and H during pediatric EEG recording. A total of 60 children with a mean age of 43.3 ± 33 months (CH) and 39.7 ± 29 months (H) were involved in the study. Oral CH (50 mg/kg) was given to thirty children, and oral H (1 mg/kg) to another 30. Vital signs were recorded during the procedure. Sedation success of CH (96.6%) was higher than H (76.6%) (p=0.023). Mean Ramsay Sedation Score (RSS) of CH (4.8±0.7) was higher than H (3.5±1.6) (p=0.00). The mean procedure time in CH group was significantly longer (p=0.000). The CH significantly reduced the mean systolic and diastolic blood pressure compared to H (p=0.007, p=0.003, respectively). SO2 of a patient from CH group decreased to 87%, and vomiting (6.6%) and agitation (3.3%) were observed in two patients. Our findings indicate that CH, due to it’s higher success rate, can be preferred in children who need sedation for EEG. However, in patients who have limited time, H with a shorter total procedure time can be preferred. More comprehensive studies are required about the effects of decreased blood pressure on systems, caused by CH.
Supporting Institution
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References
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- 17. Heistein LC, Ramaciotti C, Scott WA, et al. Chloral hydrate sedation for pediatric echocardiography:physiologic responses, adverse events, and risk factors. Pediatrics 2006; 117: 434-444.
- 18. Ashrafi MR, Azizi Malamiri R, Zamani GR, et al. Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate. Iran J Child Neurol 2013; 7: 15-19.
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- 20. Motas D, McDermott NB, VanSickle T, et al. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children’s hospital. Paediatr Anaesth 2004; 14: 256-260.
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- 23. Vade A, Sukhani R, Dolenga M, et al. Chloral hydrate sedation of children undergoing CT and MR imaging: safety as judged by American Academy of Pediatrics guidelines. AJR Am J Roentgenol 1995; 165: 905-909.
- 24. Greenberg SB, Faerber EN, Aspinall CL, et al. High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacyin relation to age. AJR Am J Roentgenol 1993; 16: 639-641.
- 25. Soergel M, Kirschstein M, Busch C, et al. Oscillometric twentyfour-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178-184.
- 26. Chen Z, Lin M, Huang Z, et al. Efficacy of chloral hydrate oral solution for sedation in pediatrics: a systematic review and meta-analysis. Drug Des Devel Ther 2019; 3: 2643-2653.
- 27. Fong CY, Tay CG, Ong LC, et al. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. Cochrane Database Syst Rev. 2017 Nov 3; 11(11): CD011786. doi: 10.1002/14651858.CD011786.pub2. PMID: 29099542; PMCID: PMC6486182.
Year 2021,
Volume: 2 Issue: 1, 31 - 38, 25.01.2021
Abstract
References
- 1. Angus-Leppan H. Seizures and adverse events during routine scalp electroencephalography: A clinical and EEG analysis of 1000 records. Clin Neurophysiol 2007; 118: 22-30.
- 2. Liamsuwan S, Grattan-Smith P, Fagan E, et al. The value of partial sleep deprivation as routine measure in pediatric electroencephalography. Journal of Child Neurology 2000; 15: 26-29.
- 3. Sezer T, Alehan F. Chloral hydrate versus hydroxyzine HCL for sedation prior to pediatric sleep EEG recording. Int J Neurosci 2013; 123: 719-723.
- 4. Olson DM, Sheehan MG, Thompson W, et al. Sedation of children for electroencephalograms. Pediatrics 2001; 108: 163-165.
- 5. Fallah R, Alaei A, Akhavan Karbasi S, et al. Chloral hydrate, chloral hydrate-promethazine and chloral hydrate-hydroxyzine efficacy in electroencephalography sedation. Indian J Pediatr 2014; 81: 541-546.
- 6. Dirani M, Nasreddine W, Melhem J, et al. Efficacy of the Sequential Administration of Melatonin, Hydroxyzine, and Chloral Hydrate for Recording Sleep EEGs in Children. Clin EEG Neurosci 2017; 48: 41¬¬-47. 7. Bektas O, Arıca B, Teber S, et al. Chloral hydrate and/or hydroxyzine for sedation in pediatric EEG recording Received. Brain Dev 2014; 36: 130-136.
- 8. Faytrouny M, Okte Z, Kucukyavuz Z. Comparison of two different dosages of hydroxyzine for sedation in the paediatric dental patient. Int J Paediatr Dent 2007; 17: 378-382.
- 9. Coté CJ, Wilson S. Work Group on Sedation. Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update. Pediatrics 2006; 118: 2587-2602.
- 10. American Society of Anesthesiologists. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology 2002; 96: 1004-1017.
- 11. Bailey PL, Pace NL, Ashburn MA, et al. Frequent hypoxemia and apnea after sedation with Midazolam and Fentanyl. Anesthesiology 1990; 73: 826-830.
- 12. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research 2011; 21: 69-72.
- 13. Dublin A. Distrubances of Rate and Rhythm of the Heart. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pedıatrics, Philadelphia: Saunders Elsevier; 2007, p.1942-1950.
- 14. Bernstein D. Evaluation of the Cardiovascular System. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pedıatrıcs, Philadelphia: Saunders Elsevier; 2007, p.1857-1864.
- 15. Ramsay MA, Savege TM, Simpson BR, et al. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 22: 656-659.
- 16. Ronchera-Oms CL, Casillas C, Marti-Bonmati L. Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging. J Clin Pharm Ther 1994; 19: 239-243.
- 17. Heistein LC, Ramaciotti C, Scott WA, et al. Chloral hydrate sedation for pediatric echocardiography:physiologic responses, adverse events, and risk factors. Pediatrics 2006; 117: 434-444.
- 18. Ashrafi MR, Azizi Malamiri R, Zamani GR, et al. Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate. Iran J Child Neurol 2013; 7: 15-19.
- 19. De Jonghe B, Cook D, Appere-De-Vecchi C, et al. Using and understanding sedation scoring systems: a systematic review. Intensive Care Med 2000; 26: 275-285.
- 20. Motas D, McDermott NB, VanSickle T, et al. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children’s hospital. Paediatr Anaesth 2004; 14: 256-260.
- 21. Malviya S, Voepel-Lewis T, Tait AR, et al. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002; 88: 241-245. 22. Coté, C. J, Wilson, S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatric dentistry 2016; 38, 13E-39E.
- 23. Vade A, Sukhani R, Dolenga M, et al. Chloral hydrate sedation of children undergoing CT and MR imaging: safety as judged by American Academy of Pediatrics guidelines. AJR Am J Roentgenol 1995; 165: 905-909.
- 24. Greenberg SB, Faerber EN, Aspinall CL, et al. High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacyin relation to age. AJR Am J Roentgenol 1993; 16: 639-641.
- 25. Soergel M, Kirschstein M, Busch C, et al. Oscillometric twentyfour-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178-184.
- 26. Chen Z, Lin M, Huang Z, et al. Efficacy of chloral hydrate oral solution for sedation in pediatrics: a systematic review and meta-analysis. Drug Des Devel Ther 2019; 3: 2643-2653.
- 27. Fong CY, Tay CG, Ong LC, et al. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. Cochrane Database Syst Rev. 2017 Nov 3; 11(11): CD011786. doi: 10.1002/14651858.CD011786.pub2. PMID: 29099542; PMCID: PMC6486182.
There are 25 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | January 25, 2021 |
| Submission Date | December 16, 2020 |
| Published in Issue | Year 2021 Volume: 2 Issue: 1 |
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