Lipshitz M, Marino B L, Sanders S T
Children's Hospital, Boston, MA 02115.
Heart Lung. 1993 Sep-Oct;22(5):408-14.
To determine the factors related to undesired effects of chloral hydrate in young children undergoing echocardiogram. Undesired effects studied were reaction to chloral hydrate before to sedation (ataxia, excitement), delayed sedation, light sleep during sedation, and behavioral changes after sedation.
Descriptive, correlational design.
Echocardiography laboratory in a pediatric teaching hospital.
140 children aged 0 to 36 months who were undergoing diagnostic echocardiography. Severity of cardiac disease ranged from benign murmur to uncorrectable lesion. Thirty children (21%) had cyanotic cardiac disease. Children were sedated with chloral hydrate per routine (mean dose 87 mg/kg) and observed from time of sedation throughout the examination. Data were collected on child's age, food ingested before sedation, transcutaneous oxygen saturation, and daytime nap schedule.
Incidence of paradoxical excitement before sedation, length of time until child reached deep sedation, depth of sleep during the examination, and behavioral changes after sedation.
Paradoxical excitement before sedation occurred in 25 children (18%). Length of time until child reached deep sedation averaged 25 minutes. Three children never fell asleep. Proximity of sedation to naptime was positively correlated to the speed of sedation. Deep sedation was achieved in 131 children (94%). Depth of sleep during the examination was related to child's age, proximity of sedation to nap time, and recent food ingestions. Older children, who were due for a nap and who had refrained from eating before the examination were most likely to remain soundly asleep throughout the examination. Children with cyanotic defects were not adversely affected by deep sedation with chloral hydrate. Most children experienced motor and affective changes after sedation.
In this sample, chloral hydrate was an effective and safe sedative. Implications for nursing include changes in scheduling practices, limiting food ingestion before sedation, and information to provide parents about chloral hydrate sedation.
确定与接受超声心动图检查的幼儿水合氯醛不良反应相关的因素。所研究的不良反应包括镇静前对水合氯醛的反应（共济失调、兴奋）、镇静延迟、镇静期间浅睡眠以及镇静后行为改变。
描述性、相关性设计。
一家儿科教学医院的超声心动图实验室。
140名年龄在0至36个月接受诊断性超声心动图检查的儿童。心脏病严重程度从良性杂音到无法矫正的病变不等。30名儿童（21%）患有紫绀型心脏病。按照常规用 水合氯醛对儿童进行镇静（平均剂量87mg/kg），并从镇静时起在整个检查过程中进行观察。收集了有关儿童年龄、镇静前摄入的食物、经皮血氧饱和度和日间小睡时间表的数据。
镇静前反常兴奋的发生率、儿童达到深度镇静的时间长度、检查期间的睡眠深度以及镇静后的行为改变。
25名儿童（18%）在镇静前出现反常兴奋。儿童达到深度镇静的平均时间为25分钟。3名儿童从未入睡。镇静时间与小睡时间的接近程度与镇静速度呈正相关。131名儿童（94%）实现了深度镇静。检查期间的睡眠深度与儿童年龄、镇静时间与小睡时间的接近程度以及最近的食物摄入有关。年龄较大、该小睡且在检查前未进食的儿童在整个检查过程中最有可能保持熟睡。紫绀型缺陷儿童未因水合氯醛深度镇静而受到不利影响。大多数儿童在镇静后出现运动和情感变化。
在该样本中，水合氯醛是一种有效且安全的镇静剂。对护理工作的启示包括改变时间安排做法、在镇静前限制食物摄入以及向家长提供有关水合氯醛镇静的信息。
