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

Published online by Cambridge University Press:  27 August 2019

Hayrullah Alp Open the ORCID record for Hayrullah Alp [Opens in a new window] ,
Ahmet M. Elmacı ,
Esma K. Alp  and
Bülent Say
Hayrullah Alp*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children’s Hospital, Konya 42285, Turkey
Ahmet M. Elmacı
Affiliation:
Division of Pediatric Nephrology, Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children’s Hospital, Konya 42285, Turkey
Esma K. Alp
Affiliation:
Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children’s Hospital, Konya 42285, Turkey
Bülent Say
Affiliation:
Department of Anesthesiology, Dr Ali Kemal Belviranlı Obstetrics and Children’s Hospital, Konya 42285, Turkey
*
Author for correspondence: H. Alp, MD, Division of Pediatric Cardiology, Department of Pediatrics, Dr Ali Kemal Belviranlı Obstetrics and Children’s Hospital, Fatih Mah. Yeni İstanbul Cd. No: 32, Selçuklu, Konya 42285, Turkey. Phone: 090 332 223 6500 (2221); Fax: 0090 332 237 60 25; E-mail: drhayrullahalp@hotmail.com
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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

Sedativeechocardiographypaediatricintranasalmidazolamketamineoralchloral hydrateinfant
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 9 , September 2019 , pp. 1189 - 1195
Copyright
© Cambridge University Press 2019 

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