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Siripermpool C, Pattrakornkul N, Thongsattra T, Jianbunjongkit N. Efficacy of Rectal Versus Oral Chloral Hydrate in Pediatric Auditory Brainstem Response: Randomized Controlled Trial. OTO Open 2024; 8:e70023. [PMID: 39351276 PMCID: PMC11439134 DOI: 10.1002/oto2.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 09/14/2024] [Indexed: 10/04/2024] Open
Abstract
Objective To compare sedation success rates between rectal (RCH) and oral chloral hydrate (OCH) administration in children undergoing auditory brainstem response (ABR) testing and assess the incidence of adverse effects. Study Design Randomized controlled trial, performed between May 2023 and August 2023. Setting Ear, Nose, and Throat Outpatient Department at tertiary care hospital. Methods Pediatric patients aged 1 to 5 years, who were indicated for ABR testing were enrolled and randomly divided into 2 groups. The control group received 10% wt/vol chloral hydrate orally at a dose of 50 mg/kg, while the other group received the same dose through rectal administration. Onset of sedation, duration of sedation, recovery time, vital signs, and adverse effects were recorded and analyzed to assess sedative effectiveness and safety. Results Eighty-eight children were randomly assigned to RCH or OCH administration groups, the sedation success rates of RCH and OCH groups were 84.09% and 90.91%, respectively (P = .33). Adverse effects were detected in 11 children (12.5%), with a vomiting rate of 20.45% in the oral group versus 0% in the rectal group (P = .002). The diarrhea rate was 4.55% in the rectal group versus 0% in the oral group (P = .16). In either group, no serious adverse effects were documented. Conclusion RCH and OCH are both safe and effective for short-term sedation in pediatric patients during ABR testing. Interestingly, RCH administration offers a high success rate without vomiting or major adverse effects. This study established the effectiveness of RCH for sedation in children under specialized supervision.
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Affiliation(s)
- Chutaporn Siripermpool
- Department of Pharmacy, Burapha University Hospital, Faculty of MedicineBurapha UniversityChonburiThailand
| | | | - Thanitda Thongsattra
- Out Patient Department of Ear Nose and Throat, Faculty of MedicineBurapha UniversityChonburiThailand
| | - Narit Jianbunjongkit
- Department of Otorhinolaryngology, Faculty of MedicineBurapha UniversityChonburiThailand
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Park M, Um J, Kim SH, Yoon J, Lee Y, Kwon J, Baek S, Kim DY. Correlation between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients in South Korea: a prospective cohort study. CHILD HEALTH NURSING RESEARCH 2023; 29:51-59. [PMID: 36760112 PMCID: PMC9925303 DOI: 10.4094/chnr.2023.29.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study investigated correlations between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients. METHODS With parental consent, 84 children who were placed under moderate or deep sedation with chloral hydrate for examinations from November 19, 2020 to July 9, 2022 were recruited. RESULTS Patients' average age was 19.9 months. Pediatric neurology patients and those who underwent electroencephalography took significantly longer to achieve sedation with chloral hydrate. There was a negative correlation between the time to achieve sedation and actual sleep time within 24 hours prior to the examination. Positive correlations were found between the actual sleep time 24 hours prior to the examination and the second dose per weight, as well as between the sedation recovery time and awake hours before the examination. CONCLUSION Sleep restriction is not an effective adjuvant therapy for chloral hydrate sedation in children, and sedation effects vary according to pediatric patients' characteristics. Therefore, it would be possible to reduce the unnecessary efforts of caregivers who restrict children's sleep for examinations. It is more important to educate parents about safe sedation than about sleep restriction.
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Affiliation(s)
- Mijung Park
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ji Um
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - So Hyun Kim
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jiseon Yoon
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yeonjae Lee
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jiyeong Kwon
- Registered Nurse, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seonhee Baek
- Registered Nurse, Unit Manager, Pediatric Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dong Yeon Kim
- Registered Nurse, Unit Manager, Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea,Corresponding author Dong Yeon Kim Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea TEL: +82-2-2258-9901 FAX: +82-2-2258-2922 E-MAIL:
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Going the Extra Mile: Why Clinical Research in Cystic Fibrosis Must Include Children. CHILDREN 2022; 9:children9071080. [PMID: 35884064 PMCID: PMC9323167 DOI: 10.3390/children9071080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
This is an exciting time for research and novel drug development in cystic fibrosis. However, rarely has the adage, “Children are not just little adults” been more relevant. This article is divided into two main sections. In the first, we explore why it is important to involve children in research. We discuss the potential benefits of understanding a disease and its treatment in children, and we highlight that children have the same legal and ethical right to evidence-based therapy as adults. Additionally, we discuss why extrapolation from adults may be inappropriate, for example, medication pharmacokinetics may be different in children, and there may be unpredictable adverse effects. In the second part, we discuss how to involve children and their families in research. We outline the importance and the complexities of selecting appropriate outcome measures, and we discuss the role co-design may have in improving the involvement of children. We highlight the importance of appropriate staffing and resourcing, and we outline some of the common challenges and possible solutions, including practical tips on obtaining consent/assent in children and adolescents. We conclude that it is unethical to simply rely on extrapolation from adult studies because research in young children is challenging and that research should be seen as a normal part of the paediatric therapeutic journey.
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:355-359. [PMID: 35753930 DOI: 10.1016/j.redare.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/04/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, Spain.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, Spain
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3,132 cases. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00135-3. [PMID: 34565574 DOI: 10.1016/j.redar.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, España.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, España
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Nie Q, Hui P, Ding H, Wang Z. Rectal chloral hydrate sedation for computed tomography in young children with head trauma. Medicine (Baltimore) 2021; 100:e25033. [PMID: 33655976 PMCID: PMC7939168 DOI: 10.1097/md.0000000000025033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
Children evaluated in the emergency department for head trauma often undergo computed tomography (CT), with some uncooperative children requiring pharmacological sedation. Chloral hydrate (CH) is a sedative that has been widely used, but its rectal use for child sedation after head trauma has rarely been studied. The objective of this study was to document the safety and efficacy of rectal CH sedation for cranial CT in young children.We retrospectively studied all the children with head trauma who received rectal CH sedation for CT in the emergency department from 2016 to 2019. CH was administered rectally at a dose of 50 mg/kg body weight. When sedation was achieved, CT scanning was performed, and the children were monitored until recovery. The sedative safety and efficacy were analyzed.A total of 135 children were enrolled in the study group, and the mean age was 16.05 months. The mean onset time was 16.41 minutes. Successful sedation occurred in 97.0% of children. The mean recovery time was 71.59 minutes. All of the vital signs were within normal limits after sedation, except 1 (0.7%) with transient hypoxia. There was no drug-related vomiting reaction in the study group. Adverse effects occurred in 11 patients (8.1%), but all recovered completely. Compared with oral CH sedation, rectal CH sedation was associated with quicker onset (P < .01), higher success rate (P < .01), and lower adverse event rate (P < .01).Rectal CH sedation can be a safe and effective method for CT imaging of young children with head trauma in the emergency department.
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Affiliation(s)
- Quanmin Nie
- Department of Neurosurgery, Weifang People's Hospital, Weifang
| | - Peiquan Hui
- Department of Neurosurgery, Weifang People's Hospital, Weifang
| | - Haitao Ding
- Department of Neurosurgery, Linyi Central Hospital, Yishui, Shandong, China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang
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Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests. Int J Pediatr Otorhinolaryngol 2019; 126:109605. [PMID: 31369972 DOI: 10.1016/j.ijporl.2019.109605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Chloral hydrate is a sedative that has been used for many years in clinical practice and, under proper conditions, gives a deep and long enough sleep to allow performance of objective hearing tests in young children. The reluctance to use this substance stems from side effects reported over time that can vary, depending on dose, procedure settings and immediate life supporting intervention when needed. Our study adds to those that have appeared in recent years, showing that chloral hydrate is an effective and safe substance when is used in proper conditions. METHODS The study included 322 children who needed sedation for objective hearing tests, from April 2014 to March 2018. Parents were instructed to bring the child tired and fasted for at least 2 h before sedation. The sedative was administered by trained staff in the hospital, and the child was monitored until awaking. RESULTS In our study group, over half of the children were in the age 1-4 years group, and only 15% were older than 4 years. The dose of chloral hydrate ranged between 50 and 83 mg/kg body weight, with an average of 75 mg. Successful sedation occurred in 94.1% of children; 0.9% of children awoke during testing and required supplemental sedation or rescheduling of the testing. The most common side effects were vomiting, agitation, prolonged sleep, and failure to fall asleep. CONCLUSIONS Comparing the side effects of chloral hydrate in our study with those from other studies, ours were similar to those described in the literature. In our study chloral hydrate was effective and had only limited adverse effects. The use of chloral hydrate under hospital conditions with proper monitoring could be a practical and safe solution for outpatients or those with short-term hospitalisation.
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1-Trichloromethyl-1,2,3,4-tetrahydro-beta-carboline (TaClo) Alters Cell Cycle Progression in Human Neuroblastoma Cell Lines. Neurotox Res 2017; 32:649-660. [PMID: 28721631 DOI: 10.1007/s12640-017-9782-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022]
Abstract
1-Trichloromethyl-1,2,3,4-tetrahydro-β-carboline, abbreviated as TaClo, is an endogenous neurotoxin capable of formation in the brain through the condensation of neuronal tryptamine with ingested exogenous toxins such as trichloroethylene or chloral hydrate. Due to its structural resemblance to 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine (MPTP), and similar ability to inhibit mitochondrial complex I, TaClo has been implicated in the etiology of Parkinson's disease. Previous studies have shown the cytotoxicity of TaClo in various cell culture models. In this study, we were interested in identifying the early molecular events within the cell upon exposure to TaClo, a potent mitochondrial toxin. We found increased phosphorylation of 5'-adenosine monophosphate-activated protein kinase (AMPK), induction of autophagy, and a dependence on glycolysis as some of the downstream events to TaClo treatment. Furthermore, TaClo-treated cells undergo accelerated late proliferation but form daughter cells containing fewer neurites, leading to their eventual apoptosis. We also found that TaClo inhibits neuronal prostaglandin E2 synthesis which may play an important role in synaptic plasticity. These results show that TaClo-mediated inhibition of mitochondrial complex I have multiple effects on cellular physiology which are in line with other mitochondrial effectors of Parkinson's disease.
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