The Effect of Fasting Practice on Sedation With Chloral Hydrate

Pediatric Anesthesia Unit, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 52621.
Pediatric emergency care (Impact Factor: 1.05). 01/2005; 20(12):805-7. DOI: 10.1097/01.pec.0000148027.53598.b8
Source: PubMed


Infants undergo various painless imaging procedures frequently. Mild sedation is required in such cases to reduce anxiety as well as to ensure optimal performance of the procedure. The most frequently used sedative as a single drug is chloral hydrate. The issue of preprocedural fasting is a subject of contention. The purpose of this study was to assess the effect of the American Academy of Pediatrics (AAP)/American Society of Anesthesiology (ASA) fasting practice guidelines on the efficacy and success of the sedation with chloral hydrate.
The sedation records of 200 infants from 2 hospitals who underwent auditory brainstem response for evaluation of hearing loss were evaluated retrospectively. In the first hospital (group A), strict nulla per os (NPO) guidelines were followed in accordance with the guidelines published by the AAP/ASA, whereas in the second hospital (group B), no fasting period was required. All children were premedicated with chloral hydrate. We evaluated the sedation failure rate, total dose of chloral hydrate needed, adverse effects, overall sleep time, and time to discharge.
The average fasting period as expected was significantly longer in group A patients than in group B patients (5.7 +/- 1.7 vs. 2 +/- 0.2 hours; P < 0.001). Group A patients demonstrated a significantly higher failure rate to achieve sedation with the first dose of chloral hydrate compared with group B patients (21% vs.11%; P = 0.03), hence needing higher doses (83 +/- 31 vs. 61 +/- 21 mg/kg; P < 0.01), and were sedated for longer periods (103 +/- 42 vs. 73 +/- 48 minutes; P < 0.001) and discharged later. No difference was found in the adverse effect rate.
Fasting was associated with an increased failure rate of the initial sedation. As a consequence, an increased total dose of chloral hydrate was required inducing a prolonged sedation time. Presumably, this is a result of the fact that a hungry child is irritable and therefore more difficult to sedate.

Download full-text


Available from: Ilan Keidan,
90 Reads
  • Source
    • "The need for pre-sedational fasting to reduce the risk of aspiration has been losing ground. Keidan et al. [12] showed that fasting was associated with an increased failure rate of initial sedation and found that fasting increased the total dose of CH required and this in turn increased the sedation time. Further, unlike in elective diagnostic procedures such as MRI and EEG, an injured child visits a medical institution due to an accident and are likely not to have fasted in advance. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chloral hydrate (CH) is the primary agent most commonly used for pediatric sedation prior to diagnostic, therapeutic procedures. In the management of pediatric facial laceration, the initial dose of CH has to balance the need for adequate sedation against the need to minimize sedative complications. A retrospective review of medical records of 834 children who visited our emergency room for facial lacerations from August 2010 to September 2012 was conducted. They were divided into six groups on the basis of the initial dose of CH administered. Further, each group was compared with the standard group (70 to ≤80 mg/kg) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay. With respect to the complication rate, only group 1 (range, 40 to ≤50 mg/kg) showed a significantly lower complication rate. In the case of all the other variables considered, there were no significant differences among any of the groups. An initial CH dose of 48±2 mg/kg does not negatively affect the success rate of sedation or the need for additional sedative during the primary closure of facial lacerations in pediatric patients. Further, lower doses reduce the incidences of adverse effects and do not delay procedure readiness. Therefore, 48±2 mg/kg of CH can be considered the optimal initial dose for pediatric sedation.
    Archives of Plastic Surgery 01/2014; 41(1):40-4. DOI:10.5999/aps.2014.41.1.40
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this controlled-crossover study was to determine the frequency of vomiting during nitrous oxide / oxygen analgesia (NOA) and assess the relationship between fasting status and vomiting. One hundred and thirteen children (64 male, 49 female), ranging in age from 24-160 months (mean = 74) and a mean weight of 23 kg (range 11-60 kg), participated in the study. At the initial examination, subjects were randomly assigned to be either fasting on the first appointment and non-fasting during the second appointment or alternatively be non-fasting for the first appointment and fasting for the second. The average time interval between eating and treatment in the fasting sessions was 6 hours and in the non-fasting group, 1 hour before treatment. Vomiting occurred in only one subject, immediately after cessation of treatment resulting in a frequency of 1% of subjects or 0.5% of sessions. No other differences were found between fasting and non-fasting subjects. During dental treatment with NOA using the rapid induction method, constant nonfluctuating concentration/ flow, and treatment time of under 35 minutes, the frequency of vomiting during NOA was found to be 0.5%.
    Pediatric dentistry 01/2008; 30(5):414-9. · 0.56 Impact Factor
Show more