title: Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine.
abstract: BACKGROUND
  Chloral hydrate, a commonly used sedative in children during noninvasive diagnostic procedures, is associated with side effects like prolonged sedation, paradoxical excitement, delirium, and unpleasant taste. Dexmedetomidine, a highly selective α-2 agonist, has better pharmacokinetic properties than chloral hydrate. We conducted this prospective, double-blind, randomized controlled trial to evaluate efficacy of intranasal dexmedetomidine with that of a second oral dose of chloral hydrate for rescue sedation during magnetic resonance imaging (MRI) studies in infants.
  
  
  METHODS
  One hundred and fifty infants (age group: 1-6 months), who were not adequately sedated after initial oral dose of 50 mg · kg(-1) chloral hydrate, were randomly divided into three groups with the following protocol for each group. Group C: second oral dose chloral hydrate 25 mg · kg(-1); Group L and Group H: intranasal dexmedetomidine in a dosage of 1 and 2 mcg · kg(-1), respectively. Status of sedation, induction time, time to wake up, vital signs, oxygen saturation, and recovery characteristics were recorded.
  
  
  RESULTS
  Successful rescue sedation in Groups C, L, and H were achieved in 40 (80%), 47 (94%), and 49 (98%) of infants, respectively, on an intention to treat analysis, and the proportion of infants successfully sedated in Group H was more than that of Group L (P ˂ 0.01). There were no significant differences in sedation induction time; however, the time to wake up was significantly shorter in Group L as compared to that in Group C or H (P < 0.01). No significant adverse hemodynamic or hypoxemic effects were observed in the study.
  
  
  CONCLUSIONS
  Intranasal dexmedetomidine induced satisfactory rescue sedation in 1- to 6-month-old infants during MRI study, and appears to cause sedation in a dose-dependent manner.
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Zixin
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Xingrong
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Yanting
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Tian
authors.affiliation: Department of Anesthesiology, Guangzhou Women & Children's Medical Center, Guangzhou, China.
authors.forename: Bilian
authors.initials: B
authors.lastname: Li
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000494:pharmacology*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate; D020927:Dexmedetomidine
keywords: chloral hydrate; deep sedation; dexmedetomidine; intranasal administration