신생아에서 Chloral Hydrate의 부작용의 빈도와 관련 인자
Adverse Effects of Chloral Hydrate in Neonates: Frequency and Related Factors
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목적: Chloral hydrate는 검사 시 진정 목적으로 흔히 사용하는 약물이나 신생아에 관해서는 충분한 연구가 이루어지지 않고 있다. 이에 저자들은 신생아중환자실에서 chloral hydrate의사용 시에 나타나는 부작용의 빈도와 그에 영향을 미치는 요소에 대해 알아보고자 한다. 또한 chloral hydrate만으로 진정이되지 않아 추가 약물을 투여하는 경우 부작용이 증가하는지에 관해 알아보고자 한다. 방법: 2010년 3월부터 2011년 2월까지 가톨릭대학교 서울성모병원 신생아중환자실에서 검사 시 진정 목적으로 chloral hydrate를 사용한 104명을 대상으로 의무기록을 후향적으로조사하였다. 결과: Chloral hydrate 투여 시 부작용은 41.3%에서 나타났으며 산소 포화도 감소(18.8%), 무호흡 증가(17.5%), 서맥 증가(10%), 수유량 감소(3.8%)가 있었다. Chloral hydrate 투여 시부작용은 chloral hydrate 투여 시기에 산소 투여 여부와 관련이 있었다(odds ratio [OR], 10.911; 95% confidence interval [CI], 2.082-57.178). 추가 약물 투여는 chloral hydrate 투여 시산소 투여 여부와 관련이 있었고(OR, 4.151; 95% CI, 1.455-11.840) chloral hydrate 단독 투여 군에 비해 수유량 감소를 제외하고는 부작용에 유의한 차이가 없었다. 결론: 진정 요법이 필요한 검사 시 산소를 투여하고 있는 신생아에서 chloral hydrate의 사용은 부작용이 나타날 가능성이높고 추가 약물 투여의 가능성이 높다. 추가 약물 투여가 필요한경우에는 진정 유도 후 나타나는 수유량 감소에 주의하면서 진정을 유도할 수 있겠다.
Abstract
Purpose: Chloral hydrate is a common drug frequently used for procedural sedation. But data on chloral hydrate use in the newborns are limited. This study examined the frequency of adverse effects of chloral hydrate and factors related to the adverse effects. We also examined if there were additional adverse effects when an additional sedative was used. Methods: The medical records of 104 patients admitted to Seoul St. Mary’s Hospital from March 2010 to February 2011 who used chloral hydrate for procedural sedation were retrospectively reviewed. Results: Adverse effects after administration of chloral hydrate were noted in 41.3% of the 104 patients. The adverse events included oxygen desaturation (18.8%), increase in apneic episodes (17.5%), increase in bradycardia (10%), and feeding intolerance (3.8%). Using oxygen at the time of chloral hydrate administration was independently associated with adverse effects (odds ratio [OR], 10.911; 95% confidence interval [CI], 2.082-57.178) and with the necessity for an additional sedative after administration of chloral hydrate (OR, 4.151; 95% CI, 1.455-11.840). Using one additional sedative agent after chloral hydrate showed no difference in adverse effects except feeding intolerance. Conclusion: Patients dependent on oxygen at the time of chloral hydrate administration may were found to be at higher risk for adverse effect of chloral hydrate and for an additional sedative. When an additional sedative is needed, it could be used with monitoring feeding intolerance after chloral hydrate administration.
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