Chloral hydrate as a sedating agent for neurodiagnostic procedures in children

摘要: Background Paediatric neurodiagnostic investigations, including brain neuroimaging and electroencephalography (EEG), play an important role in the assessment of neurodevelopmental disorders. The use appropriate sedative agent is to ensure successful completion procedures, particularly children, who are usually unable remain still throughout procedure. Objectives To assess effectiveness adverse effects chloral hydrate as a for non-invasive procedures children. Search methods We used standard search strategy Cochrane Epilepsy Group. We searched MEDLINE (OVID SP) (1950 July 2017), Central Register Controlled Trials (CENTRAL) (the Library, Issue 7, Embase (1980 Group Specialized (via CENTRAL) using combination keywords MeSH headings. Selection criteria We included randomised controlled trials that assessed against other agent(s), non-drug or placebo children undergoing procedures. Data collection analysis Two review authors independently studies their eligibility, extracted data, risk bias. Results were expressed terms ratio (RR) dichotomous mean difference (MD) continuous with 95% confidence intervals (CIs). Main results We 13 total 2390 children. all conducted hospitals provided services. Most proportion sedation failure during procedure, time adequate sedation, potential associated agent. The methodological quality was mixed, reflected by wide variation 'Risk bias' profiles. Blinding participants personnel not achieved most studies, three had high bias selective reporting. Evaluation efficacy agents also underpowered, comparisons performed single small studies. Children received oral lower when compared promethazine (RR 0.11, CI 0.01 0.82; 1 study, moderate-quality evidence). Children higher after one dose those intravenous pentobarbital 4.33, 1.35 13.89; low-quality evidence), but two doses there no evidence significant between groups 3.00, 0.33 27.46; very appeared have more music therapy, low this outcome 17.00, 2.37 122.14; study). Sedation rates similar hydrate, dexmedetomidine, hydroxyzine hydrochloride, midazolam. Children shorter achieve dexmedetomidine (MD -3.86, -5.12 -2.6; hydrochloride -7.5, -7.85 -7.15; -12.11, -18.48 -5.74; rectal midazolam -95.70, -114.51 -76.89; However, took longer 19, 16.61 21.39; evidence) intranasal 12.83, 7.22 18.44; evidence). No data available procedure without interruption child awakening. did measured specific validated scales, except comparison versus promethazine. Compared nausea vomiting 12.04 1.58 91.96). No events significantly (including behavioural change, oxygen desaturation) although increased overall 7.66, 1.78 32.91; evidence). Authors' conclusions The several methods variable. Oral appears rate paediatric procedures. such midazolam. When rate. it must be noted outcomes therapy quality, therefore corresponding findings should interpreted caution. Further research determine on major clinical requirements additional agent, degree which rarely review. safety profile studied further, especially bradycardia, hypotension, desaturation.