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Kaur H, Srivastava K, Karmakar S, Dhumak N, Lalwani S, Panda BK. Melatonin and Triclofos Sodium to Execute Sleep Electroencephalography in Pediatric Patients: A Cost-Effectiveness Analysis Alongside a Randomized Controlled Trial. Indian J Pediatr 2023; 90:893-898. [PMID: 35838942 DOI: 10.1007/s12098-022-04246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/29/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate cost-effectiveness between oral sedatives melatonin and triclofos sodium used to perform sleep electroencephalography (EEG) in pediatric patients and develop a criterion for resource allocation by the institution. METHODS This prospective study was conducted alongside the randomized controlled trial conducted at a tertiary care hospital, wherein pediatric patients arriving for sleep EEG were randomized to receive melatonin dosed at 0.3 mg/kg (< 10 kg), 3 mg (10-15 kg), and 6 mg (> 15 kg) and triclofos at 50 mg/kg (maximum dose 1 g, 6 mo to 11 y; 2 g, 11 to 18 y) after due consent. The cost-effectiveness analysis was performed from the healthcare institution's perspective. Successful EEG and abnormal EEG were the effectiveness parameters. RESULTS Two hundred twenty-eight patients were divided equally between two groups. Melatonin (N = 114) and triclofos (N = 114) recorded successful EEG in 89.4% and 91.2% patients and abnormal EEG in 49% and 42.3% patients, respectively (p > 0.05). The total direct cost incurred was INR 1881.75 (USD 26.6) and INR 2772.5 (USD 39.2) for melatonin and triclofos, respectively (p < 0.05). The cost-effectiveness ratio-1 (CER-1) for melatonin and triclofos per successful EEG recorded was INR 18.45 (USD 0.39) and INR 26.66 (USD 0.58), respectively. The CER-2 for melatonin and triclofos per abnormal EEG detected was INR 37.64 (USD 0.53) and INR 63.01 (USD 0.89), respectively. CONCLUSIONS Melatonin is more cost-effective than triclofos when charged based on individual dose requirements. Hospitals, diagnostic centers, healthcare institutions may consider resource-utilization-based costing system for cost-effective allocation of resources.
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Affiliation(s)
- Harsimran Kaur
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to Be University), Pune, Maharashtra, 411038, India
| | - Kavita Srivastava
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth (Deemed to Be University) Medical College and Hospital, Pune, Maharashtra, India
| | - Suparna Karmakar
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to Be University), Pune, Maharashtra, 411038, India
| | - Nirmala Dhumak
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to Be University), Pune, Maharashtra, 411038, India
| | - Siddhant Lalwani
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to Be University) Medical College and Hospital, Pune, Maharashtra, India
| | - Bijoy Kumar Panda
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to Be University), Pune, Maharashtra, 411038, India.
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Shaf A, Khodarahmi A, Shahhosseini S. Comparative Study of the Effect of Oral Chloral Hydrate and Intranasal Fentanyl on Sedation in Children for Electroencephalography. IRANIAN JOURNAL OF CHILD NEUROLOGY 2023; 17:99-107. [PMID: 37637784 PMCID: PMC10448842 DOI: 10.22037/ijcn.v17i2.36019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/15/2022] [Indexed: 08/29/2023]
Abstract
Objectives Sedation and stability during electroencephalography (EEG) in pediatrics have high clinical importance. This study compares the sedative properties of oral chloral hydrate (OCH) and intranasal fentanyl (INF). Materials & Methods This study was a randomized clinical trial conducted in 2020 in Isfahan City on sixty-two pediatric candidates for EEG. Patients were randomized into two groups receiving 50 mg/kg OCH and 2 μg/kg INF thirty minutes before the process. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and oxygen saturation (O2 sat) of patients, sedation, and physician's satisfaction were measured and compared between groups. Results The HR of patients decreased significantly in both groups (P< 0.001), and the patients that received INF had significantly lower HR 15, 30, 45, and 60 minutes after drug administrations (P< 0.05). RR evaluation indicated significantly decreased RR in both groups (P< 0.001), and patients receiving INF had lower RR 30, 45, and 60 per minutes after drug administrations (P< 0.001). Both groups showed significantly increased sedation levels during the study (P< 0.001), and patients treated with INF had higher sedation levels 15, 30, and 45 minutes after drug administration. Satisfaction rates were higher among the group that received INF (P= 0.020). Conclusion The use of INF had significant analgesic and sedative effects on pediatrics undergoing EEG.
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Affiliation(s)
- Amir Shaf
- Anesthesiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Khodarahmi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedighe Shahhosseini
- Anesthesiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Audio vs. Video as a Pacifier for Pediatric Echocardiography- A Randomized Controlled Trial. Indian J Pediatr 2023; 90:526. [PMID: 36940073 DOI: 10.1007/s12098-023-04516-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
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Jain V, Kumar B, Jana M. Bone Mineral Content and Density in Healthy Term Indian Infants at the Age of 1 and 2 Years Assessed by Dual-Energy X-Ray Absorptiometry. Indian J Pediatr 2023; 90:190-192. [PMID: 36539567 DOI: 10.1007/s12098-022-04412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022]
Abstract
There is a paucity of data on the bone mineral status of infants, with no data from India. This study was undertaken to assess the bone mineral content (BMC) of the healthy term Indian infants at 1 and 2 y of age, and the influence of factors such as birth weight, gender, current size, and vitamin D levels on BMC. Anthropometry, serum 25-hydroxyvitamin-D levels, and dual-energy X-ray absorptiometry (DXA) for the lumbar spine and whole-body BMC were performed at the ages of 1 and 2 y.Mean whole-body BMC was 214.1 ± 40.8 g at 1 y (n = 131) and 327.6 ± 87.4 g at 2 y (n = 73); lumbar spine BMC was 6.9 ± 1.8 g at 1 y and 10.2 ± 3.8 g at 2 y. The chief determinants of BMC were the weight and length/height of the infant, with no effect of vitamin D levels. The BMC of Indian infants at 1 y was similar to that reported previously for Caucasian infants.
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Affiliation(s)
- Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Brijesh Kumar
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Panda PK, Panda P, Dawman L, Sharawat IK. Systematic Review and Meta-analysis of Efficacy and Safety of Melatonin and Triclofos for Inducing Adequate Sedation for Sleep Electroencephalogram in Children. J Neurosci Rural Pract 2021; 13:3-11. [PMID: 35110915 PMCID: PMC8803531 DOI: 10.1055/s-0041-1736511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Abstract
Introduction Triclofos and melatonin are commonly used oral sedatives in children for obtaining a sleep electroencephalogram (EEG) record. There has been no systematic review till now to compare the efficacy and safety of these two medications.
Objectives The review intended to compare the efficacy of oral triclofos and melatonin in children <18 years of age for inducing adequate sedation for obtaining a sleep EEG record. We also attempted to compare the adverse effects, impact on EEG record, the yield of epileptiform abnormalities, and sleep onset latency in both groups.
Methods A systematic search was conducted on “MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, and Google Scholar” till November 30, 2020, with the following keywords/the Medical Subject Headings (MESH) terms while searching: “sleep EEG,” “electroencephalogram,” “triclofos,” “melatonin” OR “ramelteon” AND “epilepsy,” “seizure,” OR “convulsion.” ROB 2.0 and ROBINS-I tool was used to determine the risk of bias. To assess heterogeneity in studies, Higgins and Thompson's I
2 method was utilized. When I
2 was more than 50%, a random effects model was utilized and a fixed-effect model was used for other parameters. To assess the presence of publication bias, Egger's test was used.
Results For describing the efficacy of triclofos in 1,284 and melatonin in 1,532 children, we selected 16 articles. The indirect comparison between the pooled estimate of all children receiving individual medications revealed comparable efficacy in obtaining successful sleep EEG record with a single dose (90 vs. 76%, p = 0.058) and repeat dose (p = 0.054), detection of epileptiform abnormalities (p = 0.06), and sleep onset latency (p = 0.06), but more proportion of children receiving triclofos had adverse effects (p = 0.001) and duration of sleep was also higher with triclofos (p = 0.001).
Conclusion Efficacy of triclofos and melatonin are comparable in inducing sleep for recording EEG in children, although triclofos is more likely to cause adverse effects. However, the level of evidence is low for this conclusion and the weak strength of recommendation for the results of this review is likely to change in the future after completion of controlled trials exploring these two medications.
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Affiliation(s)
- Prateek K. Panda
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pragnya Panda
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar K. Sharawat
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abstract
Routine electroencephalogram (EEG) has many limitations, especially the inability to capture reported habitual events in question. A prolonged EEG with synchronized video (video-EEG) overcomes some of these limitations by improving the sensitivity, specificity and the diagnostic yield by attempting to record the habitual events when they are frequent and when indicated. Video-EEG is employed commonly for the diagnosis and classification of epilepsy/epilepsy syndromes, to distinguish between seizures and seizures mimickers, for pre-surgical evaluation and in the management of critically ill children. The duration of recording would vary depending on the indication and frequency of events. Ambulatory EEG is another cost effective and convenient alternative in certain circumstances. However, availability of the machines and expertise, accessibility, affordability and labor intensive nature of the procedure limit widespread use in India. This review explores the role of video-EEG in the management of children with epileptic and non-epileptic paroxysmal events with respect to routine clinical practice in India.
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Affiliation(s)
- Lakshminarayanan Kannan
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India.
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Dinesh Nayak
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India
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Lalwani S, Srivastava K, Thakor B, Panda BK, Kaur H, Karmarkar S, Dhumak N, Rajadhyaksha S. Efficacy and tolerability of Melatonin vs Triclofos to achieve sleep for pediatric electroencephalography: A single blinded randomized controlled trial. Eur J Paediatr Neurol 2021; 34:14-20. [PMID: 34293628 DOI: 10.1016/j.ejpn.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare Melatonin with Triclofos for efficacy (proportion of successful EEG, need of augmentation, sleep onset latency (SOL), yield of discharges, duration of sleep, presence and grade of artifacts) and tolerability (adverse effect profile). METHODS A randomized trial was performed (block randomization). All children were advised regarding sleep deprivation, EEG technician administered the drug. EEG was labelled successful if at least 30 min of record could be obtained (sleep with or without awake state). Pediatric neurologist reported the EEG findings-sleep onset latency, epileptiform abnormalities and graded the artifacts (excess beta activity and movement artifacts if present). The parents were interviewed telephonically next day by a pediatric resident for any adverse effects. The parents, pediatric neurologist and pediatric resident were blinded for the drug given. RESULTS 228 children were randomized (114 each received Melatonin and Triclofos). Both the groups were comparable at baseline for age group and demographic data. The proportion of successful EEG was 89.4% in Melatonin and 91.2% in Triclofos. First dose was effective in 64% in Melatonin and 63.15% in Triclofos group. Augmentation dose was needed in 25.4% in Melatonin and 28% in Triclofos group. Mean total sleep duration was 80 min after Melatonin and 82.39 after Triclofos administration. Adverse effects were observed in 6.14% of Melatonin and 8.65% of Triclofos group. None of the results were statistically significant. CONCLUSION There was no significant difference between efficacy and tolerability of Melatonin and Triclofos. Melatonin can be safely used to achieve sleep for EEG in children.
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Affiliation(s)
- Siddhant Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Kavita Srivastava
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Bina Thakor
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Bijoy Kumar Panda
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Harsimran Kaur
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Suparna Karmarkar
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Nirmala Dhumak
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Surekha Rajadhyaksha
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
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Sethi S, Joshi G, Bloria SD, Kaushik S, Chauhan R, Meena S, Luthra A, Sarna R. Safety and efficacy of oral Triclofos in the ophthalmic evaluation of children with pediatric glaucoma: An observational study. Indian J Ophthalmol 2021; 69:83-86. [PMID: 33323581 PMCID: PMC7926148 DOI: 10.4103/ijo.ijo_457_20] [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] [Indexed: 11/25/2022] Open
Abstract
Purpose: Oral Triclofos is widely used as a sedative agent in children. However, the role of Triclofos as a sedative agent in children undergoing ophthalmological procedures has not been adequately studied. The aim of this study was to determine the safety and efficacy of oral Triclofos in children suffering from pediatric glaucoma who were undergoing ocular examination. Methods: 80 children aged less than 5 years were assessed for eligibility for the trial after taking hospital ethical committee approval. The children were administered 80 mg/kg of oral Triclofos and Ramsay sedation score was measured every 5 min starting from 20 min after administration of the drug. If the child was not adequately sedated after 30 min, additional dose of 05 mg/kg was administered every 5 min till 60 min of drug administration. The procedure was considered a failure and general anesthesia (GA) administered if Ramsay sedation score was ≤4 after 60 min of initial drug administration. Heart rate and arterial oxygen saturation were measured throughout the period of sedation. The duration of sedation and incidence of side effects was also noted. Results: A total of 73 patients underwent the study. The mean age of children was 23.4 months (SD – 14.72) and mean weight was 12 kg (SD – 3.84). The mean dose of Pedicloryl (Triclofos) used was 83.8 mg/kg and the median duration of onset was 25 min. 64 children completed examination successfully, 2 children had to be administered GA during the procedure. There were no major side effects. Conclusion: Administration of oral Triclofos in a dose of 80 mg/kg body weight was safe and effective in children less than 5 years of age undergoing ocular examination.
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Affiliation(s)
- Sameer Sethi
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Gunjan Joshi
- Department of Ophthalmology, Shimla Sanatarium, Mandi, India
| | | | | | | | - Shyam Meena
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Ankur Luthra
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Rashi Sarna
- Department of Anaesthesia, PGIMER, Chandigarh, India
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Prevalence of benign epileptiform variants from an EEG laboratory in India and frequency of their misinterpretation. Epilepsy Res 2021; 170:106539. [PMID: 33461042 DOI: 10.1016/j.eplepsyres.2020.106539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To prospectively study the prevalence of benign epileptiform variants (BEVs) and their impact on epilepsy misdiagnosis. METHODS Consecutive patients, older than one year, who underwent EEG from January 2016 to December 2019 were prospectively studied for the presence of BEVs. We used descriptions of Klass and Westmoreland (1985) to categorize the BEVs. We reviewed old EEG reports and records in patients with BEV to determine whether they were interpreted as abnormal. RESULTS Of the 1862 subjects included, 1474 (79 %) patients had epilepsy while 388 (21 %) had other diagnoses. The mean age of the subjects was 23.1 ± 15.3 years and 1111 (60 %) were males. BEVs were noted in 223 (12 %) subjects undergoing EEG. The most common BEVs were wicket waves (n = 127, 6.8 %) and small sharp spikes (n = 69, 3.7 %) while 6 Hz spike-wave discharges (0.9 %), 14 and 6 Hz positive spikes (0.6 %), rhythmic mid-temporal theta burst of drowsiness (0.4 %) and subclinical rhythmic epileptiform discharges in adults (0.2 %) were less common. Patients with BEVs were older and were more likely to have normal EEG (68.2 % vs. 55.8 %; p < 0.001). BEVs were not mentioned in any of the 282 previous EEG reports. BEVS were considered to be over-interpreted as epileptiform abnormalities in 31 of 101 (30 %) records available for review. CONCLUSION BEVs are present in 12 % of subjects undergoing EEG. BEVS are largely unrecognized and are misdiagnosed as epileptiform discharges in one third of the patients by the general neurologists.
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Chaurasia R, Jain A, Sengar NS, Pandey S. Enhancing cooperation during pediatric ultrasound: Oral midazolam versus conventional techniques. J Anaesthesiol Clin Pharmacol 2020; 36:166-171. [PMID: 33013029 PMCID: PMC7480311 DOI: 10.4103/joacp.joacp_343_17] [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: 11/22/2017] [Revised: 09/10/2018] [Accepted: 05/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Ultrasound is a safe and non-invasive method for detecting numerous pathologies. Pediatric patients are often uncooperative which leads to decreased quality and increased time of scan. We compared the conventional means alone and combination of oral midazolam for the above cited purpose. Material and Methods: This double blind prospective study (CTRI/2016/06/007030) was conducted after obtaining due approval from institutional ethical committee. One hundred Children aged 2-6 years belonging to ASA class 1 or 2, posted for high resolution ultrasonography of abdomen were included in the study. They were randomised to receive midazolam 0.3 mg/kg mixed in 20 mL of apple juice (Group I) or 20 mL of apple juice alone (Group II) 20 minutes prior to the procedure. The parameters assessed were level of cooperation, sonologist's satisfaction, total scan time, heart rate and SpO2. Results: Out of 100 patients, 44 patients of group I and 42 of group II were analysed. The cooperation score was significantly higher in Group I (35%) than Group II (19%). Likert scale revealed very satisfied and satisfied rating in 61.3% (Group I) and 21.4% (Group II). The time taken by sonologist and number of attempts were significantly less in Group I than Group II. There was no difference in discharge time between the groups. There was no reportable adverse event in either group. Conclusion: Oral midazolam is a safe and effective agent to aid routine abdominal ultrasonography in pediatric patients.
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Affiliation(s)
- Rachna Chaurasia
- Department of Radiodiagnosis, Maharani Laxmi Bai Medical College, Jhansi, India
| | - Anshul Jain
- Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India
| | | | - Shivali Pandey
- Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India
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Rathore C, Prakash S, Makwana P. Prevalence of photoparoxysmal response in patients with epilepsy: Effect of the underlying syndrome and treatment status. Seizure 2020; 82:39-43. [PMID: 32979604 DOI: 10.1016/j.seizure.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To prospectively study the prevalence of photoparoxysmal response (PPR) and its determinants in epilepsy patients. METHODS Consecutive patients, older than 2 years, undergoing EEG from January 2016 to December 2019 were prospectively studied for the presence of PPR. Patients with emergent EEG and those with only sleep record were excluded. Intermittent photic stimulation was performed as per standard techniques with frequencies from 1-30 Hz. RESULTS Of the 1893 subjects included, 1492 (78%) patients had epilepsy while 401 (22%) had other diagnoses. In epilepsy group, 1028 (68.7%) had focal epilepsy, 343 (21.6%) had generalized epilepsy, while (9.7%) patients had unclassified epilepsy. Overall, 36 (2.2%) patients with epilepsy had PPR. The mean age of these patients was 19.5 ± 9.4 years and 75% were females. PPR was noted in 5 (0.5%) patients with focal epilepsy and 31 (9%) patients with generalized epilepsies [p < 0.0001; Odds ratio: 20.3 (95% CI, 7.8 - 52.7)]. PPR was noted in 1.5% of treated and 18% of untreated patients with genetic generalized epilepsy (n = 145) and 22% of untreated patients with juvenile myoclonic epilepsy (n = 86). Patients with untreated epilepsy had 17 times higher odds of having PPR [p < 0.0001; Odds ratio: 17.6 (95% CI, 4.1 - 75.6)]. CONCLUSION Underlying epilepsy syndrome and treatment status are the two most important determinants of PPR. Variability in these two factors is largely responsible for the variable reported prevalence of PPR.
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Affiliation(s)
- Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.
| | - Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Prayag Makwana
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Kaplan E, Daka A, Weissbach A, Kraus D, Kadmon G, Milkh R, Nahum E. Triclofos Sodium for Pediatric Sedation in Non-Painful Neurodiagnostic Studies. Paediatr Drugs 2019; 21:371-378. [PMID: 31292919 DOI: 10.1007/s40272-019-00346-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Triclofos sodium (TFS) has been used for many years in children as a sedative for painless medical procedures. It is physiologically and pharmacologically similar to chloral hydrate, which has been censured for use in children with neurocognitive disorders. The aim of this study was to investigate the safety and efficacy of TFS sedation in a pediatric population with a high rate of neurocognitive disability. METHODS The database of the neurodiagnostic institute of a tertiary academic pediatric medical center was retrospectively reviewed for all children who underwent sedation with TFS in 2014. Data were collected on demographics, comorbidities, neurologic symptoms, sedation-related variables, and outcome. RESULTS The study population consisted of 869 children (58.2% male) of median age 25 months (range 5-200 months); 364 (41.2%) had neurocognitive diagnoses, mainly seizures/epilepsy, hypotonia, or developmental delay. TFS was used for routine electroencephalography in 486 (53.8%) patients and audiometry in 401 (46.2%). Mean (± SD) dose of TFS was 50.2 ± 4.9 mg/kg. Median time to sedation was 45 min (range 5-245), and median duration of sedation was 35 min (range 5-190). Adequate sedation depth was achieved in 769 cases (88.5%). Rates of sedation-related adverse events were low: apnea, 0; desaturation ≤ 90%, 0.2% (two patients); and emesis, 0.35% (three patients). None of the children had hemodynamic instability or signs of poor perfusion. There was no association between desaturations and the presence of hypotonia or developmental delay. CONCLUSION TFS, when administered in a controlled and monitored environment, may be safe for use in children, including those with underlying neurocognitive disorders.
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Affiliation(s)
- Eytan Kaplan
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel. .,Pediatric Sedation Services, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayman Daka
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avichai Weissbach
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Kraus
- Institute of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Milkh
- Pediatric Sedation Services, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Matta GS, Peddisetty RP. Impact of Etiology on Efficacy of Oral Triclofos in Recording Pediatric Electroencephalography: A Tertiary Care Center Study. J Neurosci Rural Pract 2019; 10:234-237. [PMID: 31001010 PMCID: PMC6454965 DOI: 10.4103/jnrp.jnrp_280_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives: Oral triclofos is a frequently used sedative in pediatric age to record sleep Electroencephalography (EEG). This study is aimed to assess efficacy, safety profile, need for second dose, and rescheduling of oral triclofos in relation to etiology. Materials and Methods: This is a retrospective study done enrolling all children aged 6 months to 5 years referred for EEG over 1 year. After a trial for natural sleep, the first dose of oral triclofos was given. If a child does not sleep after an hour, the second dose was given and rescheduled if does not sleep even with the second dose. Age, sex, diagnosis, sleep latency, sleep duration, adverse effects, EEG findings, patients needing second dose, and rescheduling were noted. Descriptive statistics and Chi-square test were used to analyze data. Results: A total of 384 children required oral triclofos. The common etiologies for sleep study were atypical febrile seizures, hypoxic-ischemic encephalopathy (HIE) sequelae, and behavioral disorders such as autism and attention-deficit hyperactive disorder (ADHD). Including the second dose, we were able to successfully record sleep EEG in 372 (96.8%) patients. Rescheduling was required in 3.2% of patients. Mean sleep-onset latency was 36 min and mean sleep duration was 84 min. Single dose was sufficient in 329 (85.6%) and the second dose in 55 (14.4%). Thirty (38.5%) children of HIE sequelae (P < 0.001) required the second dose followed by behavioral disorders (29.1%, P = 0.03). Irritability, vomiting, and dizziness were common side effects which resolved spontaneously. Conclusions: Oral triclofos was effective as sedative for recording EEG. Children with HIE sequelae and behavioral disorders such as autism/ADHD more commonly required second dosing and rescheduling.
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Affiliation(s)
- Gopi Srikanth Matta
- Department of Neurology, Niloufer Children's Hospital, Hyderabad, Telangana, India
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Gupta A, Gunjan, Shekhar S, Gupta S, Gupta A. Comparison of Oral Triclofos and Oral Midazolam as Premedication in Children undergoing Elective Surgery. Anesth Essays Res 2019; 13:366-369. [PMID: 31198261 PMCID: PMC6545958 DOI: 10.4103/aer.aer_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Children who have experienced previous hospital admission, operation, procedures, and needle pricks are more reactive to subsequent anesthetic procedures. Many sedative agents have been used for the purpose of premedication, but few of them can be given orally, thus avoiding the pricks. Midazolam, being one such choices, can be given orally, intranasally, and parenterally but has unpredictable response. Triclofos, available as sweet syrup, is a phosphorylated derivative of chloral hydrate, has been proven to be effective within 30 min in doses of 25–75 mg/kg. Hence, this study compares triclofos hydrochloride with midazolam oral to know the efficacy of both the drugs as premedication. Aim: This study aims to assess sedation score, level of anxiety/resistance, and behavior of the child in the preoperative period. Settings and Design: After parental and institutional approval, a total of 70 children were studied based on computer-generated randomization and divided into groups M and T of 35 each. Materials and Methods: Group M patients received oral midazolam 0.5 mg/kg. Group T patients received commercially available triclofos syrup containing 100 mg/ml of drug in dose of 75 mg/kg. The response of children to taste of premedication was noted, whether completely ingested or not. In case of vomiting, the child was excluded from further study. Statistical Analysis: Numerical variables were analyzed using Student's paired t-test and other variables using Mann–Whitney U-test, Fisher exact test, and Friedman ANOVA. Results: Sedation score at 5 min interval from 0 to 30 min showed P = 0.54, 0.71, 0.65, 0.92, 0.29, 0.42, and 0.15; none were statistically significant. Anxiety score during parental separation, intravenous cannulation, and mask application were also similar in both the groups. Conclusion: From data obtained, it can be concluded that parenteral formulation of either midazolam or triclofos can be safely used as premedicant in children.
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Affiliation(s)
- Ankesh Gupta
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Gunjan
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shashank Shekhar
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sonali Gupta
- Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | - Ajit Gupta
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Levit Y, Mandel D, Matot I. Frequency-specific auditory brainstem response testing with age-appropriate sedation. Int J Pediatr Otorhinolaryngol 2018; 108:73-79. [PMID: 29605369 DOI: 10.1016/j.ijporl.2018.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Auditory brainstem response (ABR) testing is the gold-standard procedure for hearing evaluation in pediatric patients who cannot complete a behavioral hearing test. The amount of audiological information obtained depends on the quality of the patient's sleep during the test. In this retrospective database review, we aimed to assess the amount and the characteristics of the audiological information obtained in ABR testing in pediatric patients with age-appropriate sedation. METHODS A retrospective chart review was conducted on 501 consecutive ABR sedation sessions performed between January 2014 and June 2016 at the Tel Aviv Medical Center. Oral triclofos was used for the sedation of younger patients (3-24 months) and intravenous propofol for older patients (>24 months). The dataset included 370 triclofos sessions (in 337 patients) and 131 propofol sessions (in 126 patients). RESULTS None of the children developed complications, and all were discharged on the same day of the evaluation. Among the hearing-impaired children, a mean of 10 (1.8 SD) ABR threshold measurements was obtained from propofol-sedated patients and 9.4 (2.8 SD) measurements from those sedated with triclofos (P = 0.039). The major characteristics of the hearing loss, including its degree, type, and configuration, were obtained from all propofol-sedated patients and from 95% of those sedated with triclofos. CONCLUSIONS A comprehensive evaluation of hearing status can be obtained in ABR testing with age-appropriate sedation. An average number of ∼10 threshold measurements were obtained during ABR testing with age-appropriate sedation, thus allowing for the evaluation of the degree, type and configuration of the hearing loss.
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Affiliation(s)
- Yael Levit
- Hearing Clinic, Ear, Nose and Throat Department, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - Dror Mandel
- Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Matot
- Anesthesia, Pain and Intensive Care Division, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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