Comparative Effectiveness of Intranasal Dexmedetomidine-Midazolam versus Oral Chloral Hydrate Targeting Moderate Sedation during Pediatric Transthoracic Echocardiograms.

To compare efficacy and safety of two moderate sedation regimens for transthoracic echocardiography (TTE): intranasal dexmedetomidine-midazolam (DM) versus oral chloral hydrate (CH) syrup.  This was a retrospective cohort of 93 children under 4 years of age receiving moderate sedation with either DM or CH for TTE from January 2011 through December 2014.  Forty-nine patients received oral CH and 44 received the intranasal combination of DM. The demographics between groups were similar except the DM patients were slightly older and heavier (each  < 0.05). Failure rate between groups did not reach statistical significance (CH 14.3% vs. DM 6.8%;  = 0.324). Total sedation to discharge time was similar between groups (CH 89.4 minutes vs. DM 89.6 minute;  = 0.97). Cardiopulmonary data did reveal a significantly lower heart rate (101.9 vs. 91.7;  < 0.001) and respiratory rate (23.4 vs. 21.0,  = 0.03) in the DM group, but no difference in blood pressure measurements or echo determined shortening fraction.  These data support the use of intranasal DM as a safe and efficacious method of moderate sedation for children undergoing TTE.