title: Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial.
abstract: BACKGROUND
  Procedural sedation using chloral hydrate is used in many institutions to improve the quality of transthoracic echocardiograms (TTE) in infants and young children. Chloral hydrate has limited availability in some countries, creating the need for alternative effective sedatives.
  
  
  OBJECTIVE
  The aim of our study was to compare the effectiveness of two doses of intranasal dexmedetomidine vs oral chloral hydrate sedation for transthoracic echocardiography.
  
  
  METHODS
  This is a randomized, prospective study of 150 children under the age of 3 years with known or suspected congenital heart disease scheduled for transthoracic echocardiography with sedation. Group CH received oral chloral hydrate 70 mg · kg(-1), group DEX2 received 2 μg · kg(-1) intranasal dexmedetomidine, and group DEX3 received 3 μg · kg(-1) intranasal dexmedetomidine. Acceptance of drug administration, sedation onset and duration, heart rate, and oxygen saturation, sonographer and parent satisfaction were recorded.
  
  
  RESULTS
  All patients were successfully sedated for TTE. A second sedative dose (rescue) for failed single-dose sedation was required for 4% of patients after CH, none of the patients after DEX2, and 4% of patients after DEX3. Patients in group CH had an average heart rate decline of 22% during sedation, while group DEX2 decreased 27%, and group DEX3 23% (P = 0.2180). Mean time from administration of the sedative to final patient discharge was 96 min after CH, 83 min after DEX2, and 94 min after DEX3 (P = 0.1826).
  
  
  CONCLUSIONS
  Intranasal dexmedetomidine 2 and 3 μg · kg(-1) were found to be as effective for TTE sedation as oral chloral hydrate with similar sedation onset and recovery time and heart rate changes in this study population.
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jeff
authors.identifier: http://orcid.org/0000-0003-4487-5194
authors.initials: J
authors.lastname: Miller
authors.affiliation: Department of Anesthesiology, Shanghai Children's Hospital Medical Center, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xue
authors.affiliation: Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Cincinnati, OH, USA.
authors.forename: Md
authors.initials: M
authors.lastname: Hossain
authors.affiliation: Department of Anesthesiology, Shanghai Children's Hospital Medical Center, Shanghai, China.
authors.forename: Ma-Zhong
authors.initials: MZ
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Loepke
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Kurth
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000494:pharmacology*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D007223:Infant; D008297:Male; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate; D020927:Dexmedetomidine
keywords: child; congenital heart disease; induction of anesthesia; infant; pharmacodynamics; premedications