Comparison of Efficacy and Safety of Intranasal Midazolam with Syrup Chloral Hydrate for Procedural Sedation

Abstract Background:To determine the hypnotic and analgesic effects of brimonidine, and evaluate its efficacy and safety for general anesthesia. Potentiation of pentobarbital sleeping time with brimonidine was observed in mice, as was analgesic activity of brimonidine.Methods:The median effective dose (ED50)and lethal dose (LD50) of intraperitoneally injected brimonidine were determined in hypnotized mice. In addition, LD50 of intravenously injected brimonidine, ED50 of intravenously , intramuscularly and intrarectally injected brimonidine in hypnotized rabbits were determined. The synergistic anesthetic effect of brimonidine and chloral hydrate on rabbits was evaluated. Results:Intraperitoneal injection of 10 mg/kg brimonidine enhanced the hypnotic effect of a threshold dose of pentobarbital. Intraperitoneal injection brimonidine produced dose-related analgesic effects in mice. ED50 of intraperitoneally administered brimonidine in hypnotized mice was 75.7 mg/kg, and LD50 was 379 mg/kg. The ED50 of intravenous, intramuscular and intrarectal brimonidine for hypnosis in rabbits were 5.2 mg/kg, 8.8 mg/kg and 8.7mg/kg, respectively, and LD50 of intravenous brimonidine was 146 mg/kg. Combined intravenous administration of 0.6 mg/kg brimonidine and 0.03 g/kg chloral hydrate had a synergistic anesthetic effects.Conclusions:Brimonidine elicited hypnotic and analgesic effects after systemic administration, and exhibited safety. Brimonidine enhanced the effects of other types of narcotics when combined.

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Chloral Hydrate Sedation in a Dexmedetomidine Era

Hospital Pharmacy ◽

10.1177/0018578719836639 ◽

2019 ◽

Vol 55 (4) ◽

pp. 236-239

Author(s):

Kimberley M. Farr ◽

Brady S. Moffett ◽

Jennifer L. Jones ◽

Amber P. Rogers ◽

Corrie E. Chumpitazi

Keyword(s):

Retrospective Study ◽

Hospital Pharmacy ◽

Chloral Hydrate ◽

Commercial Production ◽

Large Majority ◽

Procedural Sedation ◽

Liquid Formulation ◽

Billing Data ◽

Free Standing ◽

Primary Agent

Brief Overview: The use of chloral hydrate as the primary sedation agent has declined across the nation after commercial production of the liquid formulation ceased. Although alternative sedatives have gained popularity, some pharmacies have continued to provide oral chloral hydrate by compounding it from raw ingredients. Thus, oral chloral hydrate use has continued in children despite the availability of alternative effective agents. Objective: The purpose of this investigation was to evaluate institutional chloral hydrate utilization as the primary agent for procedural sedation. Design/Methods: We conducted a retrospective study of patients given chloral hydrate for procedural sedation from October 2010 to December 2016. The hospital pharmacy database of chloral hydrate use at our 2 free-standing children’s hospitals was reviewed and matched to procedure billing data. Results: There were 5874 chloral hydrate administrations for procedural sedation during the study period. The highest rates of use occurred in 2014, when there were 1420 chloral hydrate orders within our hospital. The large majority of sedations were for cardiac studies/procedures (n = 4250, 72.4%). Conclusions: Despite significant declines in use of chloral hydrate for procedural sedation across the country, local utilization of oral chloral hydrate remains high. Recent declines may be due to high-use clinical sites transitioning to alternative sedatives such as intranasal dexmedetomidine.

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