Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers

Abstract Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm. Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation. Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motormilestones. They were sedated with chloral hydrate. Then, the head was retracted ~ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM)muscle in a state of tension. Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-topeak amplitude of 15.39 ± 3.45 μV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults. Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.

Hidrato de cloral para captação dos Potenciais Elétricos Auditivos / Chloral Hydrate to Study Auditory Brainstem Response

O Hidrato de cloral é um sedativo usado em procedimentos pediátricos devido à pouca depressão respiratória e cardíaca. OBJETIVO: Avaliar a eficácia da droga para a captação do PEATE e sistematizar o seu emprego. MATERIAL E MÉTODO: Estudo prospectivo transversal com 41 crianças. A dose inicial de HC 10 por cento foi de 50mg/kg com reforço de 6 mg/kg administrado após 30 minutos nos casos onde não houve sedação. A efetividade da droga foi determinada pela indução do sono até 1 hora após a administração da dose inicial. A ocorrência de sono foi correlacionada com as doses (50mg ou 56mg/kg), a idade, o peso e o sexo. RESULTADOS: As 41 crianças que participaram do estudo tomaram 50mg/kg e 23 dormiram em 30 minutos, 2 apresentaram depressão respiratória; 16 crianças tomaram reforço de 6mg/kg e 13 dormiram em mais 30 minutos. A dose total de 56mg/kg apresentou um efeito estatisticamente significante na indução do sono (p<0,05) em comparação com a dose de 50mg/kg. CONCLUSÃO: O HC é uma droga com um bom efeito satisfatório com a dose de 50mg/kg seguida de mais 6mg/kg em até uma hora após a administração. Complicações podem ocorrer, independente da dose usada. ClinicalTrials.gov Identifier: NCT 00949780.

Chloral Hydrate (CH) is a sedative and hypnotic drug used in pediatric procedures owing to the low depressive effect it has on the respiratory and cardiac systems. AIM: To assess the efficacy of the drug in performing ABR and to systematize its use. MATERIALS AND METHODS: A prospective cross-sectional study with 41 children without history of heart or lung disease. The initial dose of CH at 10 percent was 50mg/Kg, with a boost dose of 6mg/Kg administered 30 minutes later in cases in which there was no sedation. Drug effectiveness was established by sleep induction by 1 hour after the administration of the initial dose. Sleep occurrence was correlated with doses (50mg or 56mg/Kg), age, weight and gender. RESULTS: All the 41 children who participated in the study took 50mg/kgof the agent and 23 of them slept within 30 minutes, 2 had respiratory complications, 16 had the 6mg/Kg boost dose and 13 fell asleep after 30 minutes. The 56 mg/kg dose presented a statistically significant effect on sleep induction (p<0.05) when compared to the 50mg/kg dose. CONCLUSION: CH produced a satisfactory effect with 50 mg/Kg dose plus 6mg/kg up to one hour after administration. Complications can occur regardless of the dose used.

A comparison of oral chloral hydrate and sublingual midazolam sedation for echocardiogram in children.

OBJECTIVE: To compare the efficacy and safety of oral chloral hydrate and sublingual midazolam to sedate the children undergoing echocardiography. MATERIAL AND METHOD: A double-blind, randomized trial study in the children judged to require sedation prior echocardiogram were performed. Two hundred sixty-four patients between 6 months and 5 years of age were randomized to chloral hydrate or midazolam groups. Either 50 mg/kg of chloral hydrate orally or 0.3 mg/kg of midazolam sublingually was given in each groups. If the child was not responded within 30 minutes after the first dose, another half dose of each drug for the second dose will be required. The action duration time, sedation score level and the ability to complete echocardiogram were collected. RESULTS: Both groups were comparable with respect to age, sex, body weight, underlying heart disease, baseline O2 saturation and functional heart classification. The children in chloral hydrate group needed the second dose for sedation more than midazolam group (10.6%, 5.3% p = 0.111). The onset, action duration and total study time were significantly shorter in midazolam than in chloral hydrate group (p < 0.001). The number of the patients who had the action duration within the optimal time (< 45 min) were significantly more cases in midazolam than in chloral hydrate group (93.1%, 43.5% p < 0.001). Success rate of echocardiogram was 99.2% in each group. There was no difference in echocardiographic time performed in both groups. The children in chloral hydrate group had deeper in level of sedation (p < 0.001). Both groups showed no significant difference in term of the ability to complete echocardiographic examination. The reaction of the children to take the medication and the number of the patients who had systemic O2 saturation change more than 5%from the baseline were higher in chloral hydrate group significantly (14.4%, 4.5% p = 0.006 and 9.9%, 3.1% p = 0.025). CONCLUSION: Sublingual midazolam at the dose of 0.3 mg/kg can be used to sedate the children at age group between 6 months to 5 years who undergoing echocardiogram with comparable rate of success and safety as 50 mg/kg of chloral hydrate orally. The less depth in the level of consciousness after sedation with midazolam compare to chloral hydrate may be advantage in a high risk patient to avoid deep sedation but may be disadvantage in case who need more comprehensive echocardiographic evaluation.

Sedative effect of oral diazepam and chloral hydrate in the dental treatment of children.

PURPOSE: The purpose was to evaluate two sedation protocols during dental sessions in anxious children. MATERIALS AND METHODS: It was a randomized and double-blind study, with each individual being his/her own control within each protocol. Furthermore, the two protocols were compared. Twenty children (36 to 84 months old) who exhibited "definitely negative" behavior according to the Frankl scale were assigned to receive oral chloral hydrate (40 mg/kg) (Group I) or Diazepam (5 mg) (Group II). Behavior during local anesthesia, application of rubber dam, cavity preparation, restorative procedures was evaluated, considering the degree of sleep, body movement, crying and overall behavior. Vital signs were assessed at three different times. The Wilcoxon, Mann-Whitney, Exact Fisher's and Spearman correlation tests were used to analyze the data. RESULTS: Group I presented higher scores for sleep during the CH session than placebo session during rubber dam application (P = 0.0431) and restoration (P = 0.0431). In Group II there was no statistically significant difference (p > 0.05). There were no statistically significant differences between sessions and groups in the evaluation of body movement, crying and vital signs. Overall behavior in the placebo session was better than in the CH session during local anesthesia, but there was no difference between the two drug regimens. There was influence of age during anesthesia and cavity preparation in Group I and during rubber dam application in Group II. It was concluded that oral diazepam and chloral hydrate had no influence on the behavior management for dental treatment with the studied sample.

A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation

Chloral hydrate and hydroxyzine are a drug combination frequently used by practitioners to sedate pediatric dental patients, but their effectiveness has not been compared to a negative control group in humans. The aim of this crossover, double-blinded study was to evaluate the effect of these drugs compared to a placebo, administered to young children for dental treatment. Thirty-five dental sedation sessions were carried out on 12 uncooperative ASA I children aged less than 5 years old. In each session patients were randomly assigned to groups P (placebo), CH (chloral hydrate 75 mg/kg) and CHH (chloral hydrate 50 mg/kg plus hydroxyzine 2.0 mg/kg). Vital signs and behavioral variables were evaluated every 15 min. Comparisons were statistically analyzed using Friedman and Wilcoxon tests. P, CH and CHH had no differences concerning vital signs, except for breathing rate. All vital signs were in the normal range. CH and CHH promoted more sleep in the first 30 min of treatment. Overall behavior was better in CH and CHH than in P. CH, CHH and P were effective in 62.5 percent, 61.5 percent and 11.1 percent of the cases, respectively. Chloral hydrate was safe and relatively effective, causing more satisfactory behavioral and physiological outcomes than a placebo.

A associação hidrato de cloral- hidroxizina tem sido utilizada na clínica odontológica para sedar crianças, mas sua efetividade ainda não foi comparada a um controle negativo em humanos. O objetivo deste estudo prospectivo foi avaliar o efeito dessas drogas, comparadas a um placebo, em crianças submetidas a tratamento odontológico. Trinta e cinco sessões de sedação foram realizadas em 12 crianças menores de 5 anos, não cooperativas, ASA classe I. Em cada sessão os pacientes foram aleatoriamente alocados para os grupos P (placebo), CH (hidrato de cloral 75 mg/kg) e CHH (hidrato de cloral 50 mg/kg mais hidroxizina 2,0 mg/kg). Sinais vitais e comportamento foram avaliados a cada 15 min, e comparados pelos testes de Friedman e Wilcoxon. Os grupos não apresentaram diferenças quanto às variáveis fisiológicas, exceto a freqüência respiratória. Todos sinais vitais registrados estiveram dentro de faixa aceitável. CH e CHH promoveram mais sono nos primeiros 30 min de tratamento. O comportamento geral foi melhor em CH e CHH do que em P. CH, CHH e P foram efetivos em 62,5 por cento, 61,5 por cento e 11,1 por cento dos casos, respectivamente. O hidrato de cloral foi seguro e relativamente efetivo, levando a resultados fisiológicos e comportamentais melhores que o placebo.

Chloralhydrate in children undergoing echocardiography.

Transthoracic echocardiography (TTE) is a painless, noninvasive and risk-free diagnostic method in children with known or suspected congenital heart disease. Sedation is frequently required for an optimal achievement of this procedure. The purpose of this study was to determine the safety and efficacy of chloral hydrate (CH) sedation in undergoing TTE. The study population included 360 patients with a median age of 19 months. (2 weeks to 8 years). The median dosage of CH given was 75 mg/kg (ranging 50 and 100 mg), with either oral or rectal administration. Oral administration could not be achieved successfully in 90 patients (20%) because of the bitter taste of the drug, in the other 108 patients (30%), vomiting occurred immediately after drug administration. Prior to CH administration and until discharge; respiratory rate; heart rate, blood pressure and oxygen saturation were recorded. Sedation was successfully achieved in 342 (95%) of the patients. No child had a clinically significant change in heart rate, blood pressure and respiratory rate during sedation. There were also no significant differences in heart rate, respiratory rate, blood pressure and oxygen saturation before and after sedation. Although CH has a bitter taste and is a gastric irritant for oral medication, because of the minimal side effects and efficacy for sedation, it remains as a safe and successful drug for use in children for TTE.

Seguridad del manejo estomatológico de pacientes pediátricos bajo sedación consciente en la clínica de odontopediatría / Safe management for dental procedures in children under concient sedative analgesia the odontopediatric clinic. Odontologic specialties unit

El objetivo fundamental del presente estudio es disminuir las indicaciones de anestesia general en los niños que se someten a rehabilitación dental. Se presenta una serie de 20 niños con edad comprendida entre 1.5 y 3 años, que se sometieron únicamente a sedación con hidroxizina a 20 mg por kg de peso e hidrato de cloral a 70 mg por kg de peso, por vía oral o por sonda nasogástrica. Se encontró una clara respuesta favorable en cuanto a la conducta observada por parte de los niños, que eliminó la actitud inconveniente clasificada como conducta Frankl II o III y permitió al cirujano efectuar la rehabilitación bucal. Asimismo se encontró una elevación del umbral al dolor, la preservación de reflejos protectores y amnesia postoperatoria en cuanto al evento quirúrgico.

Uso de hidrato de cloral nas audiometrias de tronco encefálico / Cloral hydrate use in brainsteam response audiometry

A audiometria do tronco encefálico deve ser realizada em ambiente silencioso, aconchegante e com pouca luminosidade. O relaxamento do paciente é indispensável, pois as contraçoes musculares interferem na morfologia das ondas dificultando a análise do exame. Em crianças, o relaxamento pode ser conseguido com o sono natural oou com sedativos. Relatamos a nossa experiência com o uso de hidrato de cloral a 20 por cento, como sedativo, em mil pacientes pediátricos submetidos à audiometria de tronco encefálico.

Hidrato de cloral y midazolam en sedación para electroencefalograma en niños de 1 a 5 años / Chloral hydrate and midazolam in electroencephalography sedation in children of 1 to 5 years of old

Se comparó la efectividad de hidrato de cloral y midazolam como inductores de sueño para electroencefalograma en 59 niños a los que se suministró, previa asignación al azar, por vía rectal, hidrato de cloral (50 mgùkg) (n:32) o midazolam (1 mgùkg) (n:27) y 33 niños de la misma edad y condición que durmieron espontáneamente y no requirieron sedación para realizar los registros. Se logró sueño en todos los niños tratados con hidrato de cloral ante 66,6 por ciento de los que recibieron midazolam (p< 0,01). La latencia hasta el sueño fue 21,8 ñ 17,5 min. con hidrato de cloral y 117,5 + 47,2 min. con midazolam (p< 0,01). No se observaron influencias de edad, sexo, estado del desarrollo psicomotor, tiempo de vigilia previo o intervalo desde la alimentación hasta la sedación. Estos resultados apoyan el uso de hidrato de cloral por vía rectal en niños pequeños que requieren sedación para EEG