CHLORAL HYDRATE SEDATION OF CHILDREN UNDERGOING CT AND MR-IMAGING - SAFETY AS JUDGED BY AMERICAN-ACADEMY-OF-PEDIATRICS GUIDELINES

OBJECTIVE. The purpose of this prospective study was to determine the frequency of adverse events associated with supplemented and unsupplem ented chloral hydrate sedation in a select group of children undergoin g CT or MR imaging using the revised American Academy of Pediatrics (A AP) monitoring and management guidelines for pediatric sedation. The A AP guidelines do not recommend drug selection or dosages but define pa tient selection, discharge criteria, and monitoring standards for seda ting children. SUBJECTS AND METHODS. This prospective study included 4 10 children 4 years of age or younger who were scheduled for CT and MR imaging as outpatients. Selected children were physical status 1 or 2 as determined by the American Society of Anesthesiologists physical s tatus classification and had no contraindications to sedation per our institutional sedation policy. Children younger than 1 year old receiv ed only oral incremental doses of chloral hydrate. Children 1-4 years old received hydroxyzine plus incremental doses of chloral hydrate. Ch ildren between 2 and 4 years old who were not satisfactorily sedated 3 0 min after hydroxyzine plus incremental chloral hydrate were given 2 mg/kg meperidine intramuscularly, with a maximum dose of 50 mg. All ch ildren were monitored according to the revised guidelines recommended by the committee on drugs of the AAP. Vital signs and arterial hemoglo bin oxygen saturation (SpO(2)) were monitored continuously by register ed nurses trained in pediatric advanced life support from the time of sedative drug administration until the recommended discharge criteria were met. RESULTS. Mild hypoxia (SpO(2), 90-95%) that resolved spontan eously without any therapeutic intervention was seen in 9% of the chlo ral hydrate group and in 5% of the chloral hydrate-hydroxyzine group, One child in the chloral hydrate group had severe hypoxia (SpO(2), 85- 89%), and one child in the chloral hydrate-hydroxyzine group had moder ate hypoxia (SpO(2), <85%), Both required therapeutic intervention. In both cases, the severity of the underlying medical disease was undere stimated at the time of presedation medical screening. The success rat e of sedation was 100% for all the children having CT. For those havin g MR imaging, success was 100% for children 1-4 years old and 97% for children less than 1 year old. CONCLUSION. Use of supplemented and uns upplemented chloral hydrate sedation provides effective and safe sedat ion in children if the AAP guidelines for patient selection, monitorin g, and management are followed. Careful medical screening and patient selection by knowledgeable medical personnel is important to exclude p atients at high risk for life-threatening hypoxia, Monitoring with AAP guidelines is essential for prompt detection and management of life-t hreatening hypoxia.