Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examination

• Published in: Pediatric anesthesia Vol. 27; no. 6; pp. 629 - 636
• Main Authors: Cao, Qianzhong, Lin, Yiquan, Xie, Zhubin, Shen, Weihua, Chen, Ying, Gan, Xiaoliang, Liu, Yizhi, Veyckemans, Francis
• Format: Journal Article
• Language: English
• Published: France Wiley Subscription Services, Inc 01.06.2017
• Subjects: Administration, Intranasal; Administration, Oral; Cataract - congenital; Cataract - diagnosis; Child, Preschool; chloral hydrate; Chloral Hydrate - administration & dosage; Chloral Hydrate - adverse effects; Conscious Sedation - adverse effects; Conscious Sedation - methods; dexmedetomidine; Dexmedetomidine - administration & dosage; Dexmedetomidine - adverse effects; Eye; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Infant; Male; ophthalmic examination; pediatric; Pediatrics; Physical Examination - methods; Quality; sedation; Treatment Outcome; chloral hydrate; dexmedetomidine; ophthalmic examination; sedation; pediatric
• DOI: 10.1111/pan.13148
• ISSN: 1155-5645

Summary Background and aim Pediatric ophthalmic examinations can be conducted under sedation either by chloral hydrate or by dexmedetomidine. The objective was to compare the success rates and quality of ophthalmic examination of children sedated by intranasal dexmedetomidine vs oral chloral hydrate. Methods One hundred and forty‐one children aged from 3 to 36 months (5–15 kg) scheduled to ophthalmic examinations were randomly sedated by either intranasal dexmedetomidine (2 μg·kg−1, n = 71) or oral chloral hydrate (80 mg·kg−1, n = 70). The primary endpoint was successful sedation to complete the examinations including slit‐lamp photography, tonometry, anterior segment analysis, and refractive error inspection. The secondary endpoints included quality of eye position, intraocular pressure, onset time, duration of examination, recovery time, discharge time, any side effects during examination, and within 48 h after discharge. Results Sixty‐one children were sedated by dexmedetomidine with a success rate of 85.9%, which is significantly higher than that by chloral hydrate (64.3%) [OR 3.39, 95% CI: 1.48–7.76, P = 0.003]. Furthermore, children in the dexmedetomidine group displayed better eye position in anterior segment analysis than in chloral hydrate group median difference. All children displayed stable hemodynamics and none suffered hypoxemia in both groups. Oral chloral hydrate induced higher percentages of vomiting and altered bowel habit after discharge than dexmedetomidine. Conclusions Intranasal dexmedetomidine provides more successful sedation and better quality of ophthalmic examinations than oral chloral hydrate for small children.