The use of chloral hydrate sedation in pediatric strabismus outpatient clinic

Abstract

Purpose To assess the use of oral chloral hydrate (CH) sedation in uncooperative children to perform a precise cycloplegic retinoscopy and a thorough dilated fundus examination in an outpatient strabismus and nystagmus clinic. Patients and methods A prospective study was conducted on 114 uncooperative children (119 sedation episodes) who were attending the strabismus and nystagmus outpatient clinic at Menoufia University Hospital. Children were sedated by the first dose of CH (50 mg/kg). A second dose, half-strength of the first dose, was given if no adequate sedation occurred after 30 min. The degree of sedation was graded into five categories: excellent, good, fair, poor, and failure. All demographic characteristics, sedation success, failure, and adverse events were reported and statistically analyzed. Results The mean age of children was 23.38 months (range: 5.16–62.06), and their weight ranged from 6.5 to 22 kg. The total CH dose ranged from 325 to 1500 mg. A total of 78 sedation episodes were reported by a single dose, and 41 by two doses. The percentage of the grade of sedation in our 119 episodes was as follows: excellent (56.3%), good (9.2%), fair (28.6%), poor (2.5%), and failure (3.4%). The overall success of one dose was 65.5%, which increased to 96.6% by a second supplemental dose. The most common complication was vomiting (13.4%). Other complications included prolonged drowsiness (one case) and paradoxical agitation (two cases). Spearman correlation showed a significant positive correlation between the degree of sedation and the total dose of CH (r=0.603, P<0.001). Conclusion According to our study, the use of CH was found to have a high success rate with two doses, without major adverse events.

Keywords

• chloral hydrate
• cycloplegic refraction
• dilated fundus examination
• sedation
• strabismus