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Cardiol Young. 2019 Sep;29(9):1189-1195. doi: 10.1017/S1047951119001835.

Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study.

Author information

1
Division of Pediatric Cardiology, Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya 42285, Turkey.
2
Division of Pediatric Nephrology, Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya 42285, Turkey.
3
Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya 42285, Turkey.
4
Department of Anesthesiology, Dr Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya 42285, Turkey.

Abstract

OBJECTIVE:

There are several agents used for conscious sedation by various routes in children. The aim of this prospective randomised study is to compare the effectiveness of three commonly used sedatives: intranasal ketamine, intranasal midazolam, and oral chloral hydrate for children undergoing transthoracic echocardiography.

METHODS:

Children who were referred to paediatric cardiology due to a heart murmur for transthoracic echocardiography were prospectively randomised into three groups. Seventy-three children received intranasal midazolam (0.2 mg/kg), 72 children received intranasal ketamine (4 mg/kg), and 72 children received oral chloral hydrate (50 mg/kg) for conscious sedation. The effects of three agents were evaluated in terms of intensity, onset, and duration of sedation. Obtaining high-quality transthoracic echocardiography images (i.e. absence of artefacts) were regarded as successful sedation. Side effects due to medications were also noted.

RESULTS:

There was no statistical difference in terms of sedation success rates between three groups (95.9, 95.9, and 94.5%, respectively). The median onset of sedation in the midazolam, ketamine, and chloral hydrate was 14 minutes (range 7-65), 34 minutes (range 12-56), and 40 minutes (range 25-57), respectively (p < 0.001 for all). However, the median duration of sedation in study groups was 68 minutes (range 20-75), 55 minutes (range 25-75), and 61 minutes (range 34-78), respectively (p = 0.023, 0.712, and 0.045). Gastrointestinal side effects such as nausea and vomiting were significantly higher in the chloral hydrate group (11.7 versus 0% for midazolam and 2.8% for ketamine, respectively, p = 0.002).

CONCLUSION:

Results of our prospectively randomised study indicate that all three agents provide adequate sedation for successful transthoracic echocardiography. When compared the three sedatives, intranasal midazolam has a more rapid onset of sedation while intranasal ketamine has a shorter duration of sedation. Intranasal ketamine can be used safely with fewer side effects in children undergoing transthoracic echocardiography.

KEYWORDS:

Sedative; chloral hydrate; echocardiography; infant; intranasal; ketamine; midazolam; oral; paediatric

PMID:
31451130
DOI:
10.1017/S1047951119001835

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