title: Moderate sedation for echocardiography of preschoolers.
abstract: Preschoolers frequently require sedation for echocardiograms. This study compared various sedation drugs at the authors' institution, as well as the charges for moderate versus deep sedation. From 2001 to 2007, sedation was administered to 703 patients ages 2 to 4 years. Four drug regimens were used: chloral hydrate (CH), chloral hydrate with diphenhydramine (CH + D), chloral hydrate with hydroxyzine hydrochloride (CH + H), and midazolam. The mean onset of sedation was 37 min, and the mean duration of sedation was 47 min. The CH group fell asleep the most quickly (30 min; p < 0.001), and the CH + D patients experienced the most prolonged sedations (13%; p < 0.001). Studies were completed by 97% of the chloral hydrate group, 98% of the CH + D group, and 94% of the CH + H group compared with 66% of the midazolam group (p < 0.001). Complications (7.4%) were minor and not significant for any particular medication. The charges for moderate sedation averaged $709 compared with $3,628 for deep sedation. The findings demonstrated that chloral hydrate was the fastest-acting agent and had a high success rate with minimally prolonged sedations. The low complication rate for chloral hydrate, and the much lower cost for its use to induce moderate sedation have made chloral hydrate our preference for the echocardiographic sedation of preschoolers.
authors.affiliation: The Congenital Heart Institute at Miami Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155-3009, USA. clroach@bellsouth.net
authors.forename: Carol Lafayette
authors.initials: CL
authors.lastname: Roach
authors.forename: Nazia
authors.initials: N
authors.lastname: Husain
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zabinsky
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Welch
authors.forename: Ruchira
authors.initials: R
authors.lastname: Garg
mesh_terms: D000768:Anesthesia, General / Q000191:economics; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016292:Procedural Sedation / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004155:Diphenhydramine / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000191:economics; D005260:Female; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D006919:Hydroxyzine; D002697:Chloral Hydrate; D004155:Diphenhydramine; D008874:Midazolam