소아 환자의 진정을 위한 chloral hydrate의 효과
Effect of Chloral Hydrate Used for Pediatric Sedation
0
조회
0
다운로드
7
인용
0
참고문헌
키워드
초록
Propose : Sedation is often needed to perform an imaging study or procedure on a child. Although chloral hydrate is the most commonly used drug for pediatric sedation, little data are available for its efficacy or adverse effects. This study was undertaken to evaluate the efficacy of chloral hydrate for sedation and define any problems for using this agent in children. Methods : The medical records of 324 infants and children, who were admitted at Chonnam National University Hospital from January 2005 to December 2005 were retrospectively reviewed. Age, sex, body weight, underlying diagnosis, performed procedure, dose of chloral hydrate, initial response, delayed response and other additional agents for sedation were reviewed. If the desired level(3 on the Skeie scale) was not reached within 30 min after the administration of drugs, sedation was considered as potentially failed. Results : The average age of the study group was 27 months. Among 324 patients, 107 (33.0%) failed for chloral hydrate sedation. 77(47.8%) of the neurologically impaired 161 patients and 30(18.4%) of the unimpaired 163 patients failed on sedation with chloral hydrate. Among neurologically impaired cases, who had either developmental delay or seizures or both of them, 56.8%(25/44), 50.0%(58/116) and 64.7%(22/34) in each category respectively failed on sedation with chloral hydrate. Conculsion : In neurologically impaired patients, sedation by chloral hydrate was so difficult and prone to have adverse effects that it is recommended to supplement another drug than to administer the same drug again. However, further studies on effective methods of sedation are needed.
Abstract
Propose : Sedation is often needed to perform an imaging study or procedure on a child. Although chloral hydrate is the most commonly used drug for pediatric sedation, little data are available for its efficacy or adverse effects. This study was undertaken to evaluate the efficacy of chloral hydrate for sedation and define any problems for using this agent in children. Methods : The medical records of 324 infants and children, who were admitted at Chonnam National University Hospital from January 2005 to December 2005 were retrospectively reviewed. Age, sex, body weight, underlying diagnosis, performed procedure, dose of chloral hydrate, initial response, delayed response and other additional agents for sedation were reviewed. If the desired level(3 on the Skeie scale) was not reached within 30 min after the administration of drugs, sedation was considered as potentially failed. Results : The average age of the study group was 27 months. Among 324 patients, 107 (33.0%) failed for chloral hydrate sedation. 77(47.8%) of the neurologically impaired 161 patients and 30(18.4%) of the unimpaired 163 patients failed on sedation with chloral hydrate. Among neurologically impaired cases, who had either developmental delay or seizures or both of them, 56.8%(25/44), 50.0%(58/116) and 64.7%(22/34) in each category respectively failed on sedation with chloral hydrate. Conculsion : In neurologically impaired patients, sedation by chloral hydrate was so difficult and prone to have adverse effects that it is recommended to supplement another drug than to administer the same drug again. However, further studies on effective methods of sedation are needed.
참고문헌 (17)
- Voepel-Lewis T., "Sedation failures in children undergoing MRI and CT: is temperament a factor?", Paediatr Anaesth, 10, pp.319~323 (2000)
- Sury MR., "Development of a nurse-led sedation service for paediatric magnetic resonance imaging", Lancet, 353, pp.1667~1671 (1999)
- Keeter S., "Sedation in Pediatric CT: national survey of current practice", Radiology, 175, pp.745~752 (1990)
- Holshouser BA., "Sedation, anesthesia, and physiologic monitoring during MR imaging: evaluation of procedures and equipment", J Magn Reson Imaging, 3, pp.553~558 (1993)
- Greenburg SB., "Adams RC, Mercer-Wilson DD. Sedation of difficult-to-sedate children undergoing MR imaging: value of thioridazine as an adjunct to chloral hydrate", Am J Roentgenol, 163, pp.165~168 (1994)
- Beebe DS., "Trained nurses can provide safe and effective sedation for MRI in pediatric patients", Can J Anaesth, 47, pp.205~210. (2000)
- Mason KP., "Superiority of pentobarbital versus chloral hydrate for sedation in infants during imaging", Radiology, 230, pp.537~542 (2004)
- Reimche LD., "Chloral hydrate sedation in neonates and infants: clinical and pharmacologic considerations", Dev Pharmacol Ther, 12, pp.57~64 (1989)
- Greenberg SB., "High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age", Am J Roentgenol, 161, pp.639~641 (1993)
- McCarver-May DG., "Comparison of chloral hydrate and midazolam for sedation of neonates for neuroimaging studies", J Pediatr, 128, pp.573~576 (1996)
- Goodman Gilman A., "The Pharmacological Basis of Therapeutics, 8th ed", pp.364~365 (1991), Maxwell Macmillan International Editions
- Malviya S., "Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes", Br J Anaesth, 84, pp.743~748 (2000)
- Rho YI., "Chloral hydrate sedation of pediatric outpatient for EEG: sedation effect of education of measures to promote sleeping", Med J Chosun Univ, 29(1), pp.144~150 (2004)
- Rumm PD., "Efficacy of sedation of children with chloral hydrate", South Med J, 83, pp.1040~1043 (1990)
- Skeie B., "Antagonism of flunitrazepam induced sedative effects by flumazenil in patients after surgery under general anaesthesia. A double-blind placebo-controlled investigation of efficacy and safety", Acta Anaesthesiol Scand, 32, pp.290~294 (1988)
- Jastak JT., "Death after chloral hydrate sedation: Report of a case", J Am Dent Assoc, 116, pp.:345~348 (1998)
- Robinson DN., "Paediatric sedation techniques", Curr Anaesth Crit Care, 11, pp.250~254 (2000)