ABSTRACT
The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia [PSA] to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced until now. The aim of the present study was comparison of oral chloral hydrate [OCH] and rectal sodium thiopental [RST] in pediatric PSA. In the present randomized clinical trial, 2-6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH [50mg/kg] and RST [25mg/kg] were prescribed and a trained nurse recorded the time from drug prescription to receiving the conscious sedation [onset of action], the total period which the patient has the Ramsay score>/=4 [duration of action], and adverse effect of agents. Mann-Whitney U test and chi-squared test, and Non-parametric analysis of covariance [ANCOVA] were used for comparisons. One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure [p<0.001]. The onset of action in OCH and RST groups were 24.5 +/- 6.1and 28.7 +/- 5.2 minutes, respectively [p<0.001]. Duration of action in OCH and RST groups were 12.9 +/- 2.8 minutes and 13.7 +/- 2.6 minutes, respectively [p=0.085]. Non-parametric ANCOVA revealed that only diastolic blood pressure was affected by drug prescription [p=0.001]. In 11[15.7%] patients in RST group, diarrhea was observed during 24 hours [p=0.001]. Oxygen desaturation was observed only in two patients, both in OCH group. Each of the sedative has advantages and disadvantages that should be considered when selecting one for inducing short-term sedation. It seems that rectal sodium thiopental and oral chloral hydrate are equally effective in pediatric PSA and based on patient's condition we can administrate one of these agents
ABSTRACT
Restoration of normal anatomic alignment is a key component of the treatment of distal radius fractures [DRF]. This study aimed to evaluate the accuracy of ultrasonography [US] in determining the adequacy of closed reduction in these fractures. DRF patients admitted to the emergency department of Al-Zahra Hospital, Isfahan, Iran from September 2011 to 2012, were enrolled. After closed reduction, the adequacy was investigated through both US and control plain radiography. Then, sensitivity, specificity, positive and negative predicative values of US in confirmation of closed reduction was evaluated. In addition, inter-rater agreement between the two diagnostic tools was analyzed by calculating Cohen's kappa coefficient. Finally, 154 pa-tients were evaluated [females: 53.9%] with mean age of 40.03 +/- 14.7 [range: 22-73]. US had sensitivity, specifici-ty, positive and negative predictive value of 99.3% [95%CI: 96.2-99.9], 100.0% [95%CI: 62.9-100.0], 100.0% [95%CI: 97.5-100.0], and 88.9% [95%CI: 51.7-98.1] in confirmation of the adequate reduction, respectively. In addition, inter-rater reliability was 0.94 [95%CI: 0.89-0.99; p<0.0001]. It seems that US could be considered as a highly sensitive, accurate, easy to use, noninvasive and safe tool for guidance and confirmation of closed reduction in DRF