Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors.
OBJECTIVE
The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution.


METHODS
We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed.


RESULTS
Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included > or = 20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n = 3 [0.3%]), airway obstruction (n = 15 [1.4%]), hypoxia (n = 65 [5.9%]), hypercarbia (n = 40 of 603 [6.6%]), hypotension with poor perfusion (n = 4 [0.4%]), vomiting (n = 4 [0.4%]), and prolonged sedation (n = 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors.


CONCLUSIONS
Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this pediatric population. The majority of adverse events were minor, and major events were uncommon. Infants who were younger than 6 months were found to be at higher risk for serious adverse events.
Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA. lisa.heistein@childrens.com
Lisa C
LC
Heistein
Claudio
C
Ramaciotti
William A
WA
Scott
Melanie
M
Coursey
Paul W
PW
Sheeran
Matthew S
MS
Lemler
D001794:Blood Pressure; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000009:adverse effects; D016292:Procedural Sedation; D000075202:Contraindications; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging; D006339:Heart Rate; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007223:Infant; D008991:Monitoring, Physiologic; D012307:Risk Factors
D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate