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RESEARCH PRODUCT

Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging.

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SUMMARY Sedation is routinely required for successful Magnetic Resonance imaging in infants and children. Five hundred and ninety-six paediatric patients (270 female and 326 male, age (mean±SD) 41±30 months and weight 14.8±6.5 kg) entered an open, non-comparative, prospective study to assess oral chloral hydrate sedation in a large and homogeneous paediatric population undergoing Magnetic Resonance imaging. Chloral hydrate syrup 70 mg/ml was administered 20–40 min prior to the procedure. Effective sedation was reached in 94.1% with a total dose (mean±SEM) of 68±1 mg/kg (range 20–170 mg/kg). Statistical analysis of sedation failures vs. successful examinations after the total dose showed significant differences for dose (62±4 vs. 69±1 mg/kg; Pgt;0.05), age (64±7 vs. 40±1 months; P>0.001) and weight (19.8±1-5 vs. 14.5±0.0 kg; P>0001). Effectiveness fell to around 80% in children with encephalic white matter alterations, medullary tumours or syringohydromyela (P=0.07). The mean time of onset of sedation was 26±1 min, and the mean time to spontaneous awakening after the completion of the Magnetic Resonance examination was 38±2 min. Fifty-nine children (9.9%) experienced adverse reactions, with nausea and vomiting being the most common (n=41), followed by nervousness and unusual excitement (n=6). Discriminant function analysis identified age and total dose as the quantitative variables helping to differentiate between sedation failures and satisfactory examinations (sensitivity=0.73, and specificity=0.61; r=0.20, P>0.001). Sedation failure rates were very low (>5%) for children under 36 months old, but still low (>7.5%) for children up to 7 years old. Older children ( 15%). Low sedation failure rates (>5%) and few adverse reactions (>10%) were obtained in the 61–70 mg/kg and 71-80mg/kg dose ranges. Lower doses produced higher sedation failure rates, while higher doses increased the incidence of adverse reactions. Assuming a recommended sedative paediatric dose of 70mg/kg, and the possibility to re-administer half the dose if adequate sedation was not achieved, a maximum total dose per procedure around 100 mg/kg is proposed. We conclude that oral chloral hydrate is a safe and consistently effective short-term sedative, and it probably should be considered the drug of choice in infants and children undergoing Magnetic Resonance examinations.