Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, No.1617, Riyue Avenue, Qingyang District, Chengdu, 610091, China.
Paediatr Drugs. 2022 Jul;24(4):403-412. doi: 10.1007/s40272-022-00511-4. Epub 2022 May 21.
Although chloral hydrate has been used as a sedative for more than 100 years, dozens of studies have reported that it has inconsistent sedative effects and high sedation failure rates with initial dose. The high failure rates may lead to repeated administration of sedatives, guardians' dissatisfaction, parental anxiety, increasing medical workload as well as leading to an increase of adverse events. Our aim is to identify the risk factors associated with chloral hydrate sedative failure with initial dose in children undergoing noninvasive diagnostic procedures.
Pediatric patients who underwent chloral hydrate sedation for noninvasive diagnostic procedures at our institution between 1 December 2019 and 1 January 2021 were retrospectively analyzed. Data collected included patients' age, gender, weight, sedation history, sedation failure history, type of procedures, initial dose of choral hydrate, sleep deprivation, sedation failure with initial dose, and sedative duration. The initial dose was classified into three levels: reduced dose (< 40 mg/kg), standard dose (40-60 mg/kg), and high dose (> 60 mg/kg). The patients were divided into three cohorts according to the different initial doses.
A total of 15,922 patients were included in the analysis; 1928 (12.1%) were not well-sedated after administering the initial dose of chloral hydrate. The highest sedative failure was observed in the reduced dose group. By multivariate regression, we identified that heavier weight, patients with a history of sedation or a history of sedation failure, and patients who received magnetic resonance imaging (MRI) or more than one procedure simultaneously were associated with an increased odds of sedation failure at the initial dose. However, outpatients, patients undergoing hearing screening, and patients with sleep deprivation were favored regarding chloral hydrate sedative success.
An alternative drug or drug combination is necessary in patients with heavier weight, those with a sedation history or sedation failure history, and those undergoing an MRI or more than one procedure simultaneously, whereas chloral hydrate is an appropriate sedation option for outpatients, patients undergoing hearing screening, and those with sleep deprivation.
虽然水合氯醛作为镇静剂已经使用了 100 多年，但数十项研究报告称，其初始剂量的镇静效果不一致，镇静失败率较高。高失败率可能导致反复给予镇静剂、监护人不满、父母焦虑、增加医疗工作量，并导致不良事件增加。我们的目的是确定与儿童非侵入性诊断程序中初始剂量水合氯醛镇静失败相关的风险因素。
回顾性分析了 2019 年 12 月 1 日至 2021 年 1 月 1 日期间在我院接受水合氯醛镇静进行非侵入性诊断程序的儿科患者。收集的数据包括患者的年龄、性别、体重、镇静史、镇静失败史、检查类型、水合氯醛初始剂量、睡眠剥夺、初始剂量镇静失败以及镇静持续时间。初始剂量分为三级：低剂量（<40mg/kg）、标准剂量（40-60mg/kg）和高剂量（>60mg/kg）。根据初始剂量的不同，将患者分为三组。
共纳入 15922 例患者；1928 例（12.1%）患者在给予水合氯醛初始剂量后镇静效果不佳。低剂量组的镇静效果失败率最高。通过多变量回归分析，我们发现体重较重、有镇静史或镇静失败史、同时接受磁共振成像（MRI）或多项检查的患者，初始剂量镇静失败的可能性增加。然而，门诊患者、进行听力筛查的患者和睡眠剥夺的患者更适合接受水合氯醛镇静。
对于体重较重、有镇静史或镇静失败史、同时进行 MRI 或多项检查的患者，需要使用替代药物或药物组合；而对于门诊患者、进行听力筛查的患者和睡眠剥夺的患者，水合氯醛是一种合适的镇静选择。
