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Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans—additional chloral hydrate vs intranasal dexmedetomidine
Author(s) -
Zhang Wenhua,
Wang Zixin,
Song Xingrong,
Fan Yanting,
Tian Hang,
Li Bilian
Publication year - 2016
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12824
Subject(s) - chloral hydrate , dexmedetomidine , medicine , sedation , anesthesia , sedative , chloral , organic chemistry , chemistry
Summary 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.