ARTICLES
Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging Crisanto L. Ronchera, Luis Marti-Bonmatl, Cecilio Poyatos, Josd Vilar and N. Victor Jim~nez Strawberry-flavoured chloral hydrate syrup (70 mg/ml, Clora] hidrato, Montplet & Esteban SA, Barcelona, Spain) was administered orally by a nurse 20 to 30 min before the MRI procedure. Dosage and administration was done by means of an oral administration syringe for paediatric use or by further diluting the syrup with water, milk or fruit juice. The initial dose was approximately 50 mg/kg. When it proved ineffective an additional dose was administered, which was usually one-third the initial dose and partially depended on the radiologist's subjective evaluation of the child. The children were permitted food and oral fluid before the examination. MRI was performed on a 0.5 T superconductive unit (Philips Gyroscan $5, Eindhoven, the Netherlands). Conventional spimecho and inversion recovery sequences were used, with the head coil. Intravenous access for superparamagnetic contrast media (gadopentetate dimeglumine, Magnevist, Schering AG, Berlin, FRG), if needed, was inserted with the child sedated beMethods For a period of 12 months all children receiving fore scanning. All children were observed by a nurse throughsedation before MRI at our institution were included in the study. Children less t h a n 1 m o n t h out their stay in the MRI unit, never less t h a n of age, or with severe liver or renal disease, or af- 4 h, and the adverse reactions were recorded. fected by severe central nervous system depres- Ambulatory medication and administration of sion or able to co-operate were not sedated. A any drug other t h a n chloral hydrate were noted. total of 172 paediatric patients (82 female and All images were examined for motion artifacts 90 male, age 42+_26 months, and weight by a radiologist. Effectivity was defined as conscious sedation or 14.7_+5.6 kg) were included. All procedures followed were in accordance with the Helsinki sleep together with the completion of a satisfactory examination. The presence of motion artiDeclaration of 1982.
Introduction Sedation and more suitably sleep induction is routinely required in paediatric patients undergoing diagnostic procedures, who are frequently unable to co-operate in obtaining adequate examinations without motion artifacts. Many drugs have been used at different doses and by different administration routes to produce sedation or sleep: chloral hydrate [1-8], meperidine, promethazine and chlorpromazine (the DPT, MPC or 'lytic' cocktail) [2 9-11], atropine, meperidine, promethazine and secobarbital (the AMPS cocktail) [3], barbiturates [4 9 12-14] or benzodiazepines [15-18]. However, these drugs can cause serious toxicity and are not consistently effective in all patients [19 20]. We carried out an open, non-comparative, prospective study to assess the effectivity of oral chloral hydrate in children undergoing magnetic resonance imaging (MRI), and to evaluate the factors t h a t m a y influence its effectivity.
Ronchera CL, Marti-Bonmatl L, Poyatos C, Vilar J, Jim~nez NV. Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging. Pharm Weekbl [Sci] 1992;14(6):349-52.
Keywords Children Chloral hydrate Dosage Sedation C.L. Ronchera (correspondence) and N.V. Jim~nez: Department of Pharmacy, Hospital Dr. Peset, Avenida Gaspar Aguilar 90, E-46017 Valencia, Spain. L. Marti-Bonmati, C. Poyatos and J. Vilar: Department of Diagnostic Radiology, Hospital Dr. Peset, Valencia.
14(6) 1992
Abstract Sedation is frequently required in children undergoing magnetic resonance imaging (MRI). 172 Paediatric patients (82 female and 90 male, age 42_+26 months, weight 14.7_+5.6 kg) entered an open, non-comparative, prospective study to assess the utilization of oral chloral hydrate. Chloral hydrate syrup (70 mg/ml) was administered 20-30 rain prior to the procedure. Effective sedation was reached in 80.3% with an average initial dose of 55 mg/kg and in 93.6% with an average total dose of 65 mg/kg. Significant differences in effectivity were correlated with the dose (54_+11 mg/kg in failure cases versus 66_+16 mg/kg in effective cases; p
Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging Crisanto L. Ronchera, Luis Marti-Bonmatl, Cecilio Poyatos, Josd Vilar and N. Victor Jim~nez Strawberry-flavoured chloral hydrate syrup (70 mg/ml, Clora] hidrato, Montplet & Esteban SA, Barcelona, Spain) was administered orally by a nurse 20 to 30 min before the MRI procedure. Dosage and administration was done by means of an oral administration syringe for paediatric use or by further diluting the syrup with water, milk or fruit juice. The initial dose was approximately 50 mg/kg. When it proved ineffective an additional dose was administered, which was usually one-third the initial dose and partially depended on the radiologist's subjective evaluation of the child. The children were permitted food and oral fluid before the examination. MRI was performed on a 0.5 T superconductive unit (Philips Gyroscan $5, Eindhoven, the Netherlands). Conventional spimecho and inversion recovery sequences were used, with the head coil. Intravenous access for superparamagnetic contrast media (gadopentetate dimeglumine, Magnevist, Schering AG, Berlin, FRG), if needed, was inserted with the child sedated beMethods For a period of 12 months all children receiving fore scanning. All children were observed by a nurse throughsedation before MRI at our institution were included in the study. Children less t h a n 1 m o n t h out their stay in the MRI unit, never less t h a n of age, or with severe liver or renal disease, or af- 4 h, and the adverse reactions were recorded. fected by severe central nervous system depres- Ambulatory medication and administration of sion or able to co-operate were not sedated. A any drug other t h a n chloral hydrate were noted. total of 172 paediatric patients (82 female and All images were examined for motion artifacts 90 male, age 42+_26 months, and weight by a radiologist. Effectivity was defined as conscious sedation or 14.7_+5.6 kg) were included. All procedures followed were in accordance with the Helsinki sleep together with the completion of a satisfactory examination. The presence of motion artiDeclaration of 1982.
Introduction Sedation and more suitably sleep induction is routinely required in paediatric patients undergoing diagnostic procedures, who are frequently unable to co-operate in obtaining adequate examinations without motion artifacts. Many drugs have been used at different doses and by different administration routes to produce sedation or sleep: chloral hydrate [1-8], meperidine, promethazine and chlorpromazine (the DPT, MPC or 'lytic' cocktail) [2 9-11], atropine, meperidine, promethazine and secobarbital (the AMPS cocktail) [3], barbiturates [4 9 12-14] or benzodiazepines [15-18]. However, these drugs can cause serious toxicity and are not consistently effective in all patients [19 20]. We carried out an open, non-comparative, prospective study to assess the effectivity of oral chloral hydrate in children undergoing magnetic resonance imaging (MRI), and to evaluate the factors t h a t m a y influence its effectivity.
Ronchera CL, Marti-Bonmatl L, Poyatos C, Vilar J, Jim~nez NV. Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging. Pharm Weekbl [Sci] 1992;14(6):349-52.
Keywords Children Chloral hydrate Dosage Sedation C.L. Ronchera (correspondence) and N.V. Jim~nez: Department of Pharmacy, Hospital Dr. Peset, Avenida Gaspar Aguilar 90, E-46017 Valencia, Spain. L. Marti-Bonmati, C. Poyatos and J. Vilar: Department of Diagnostic Radiology, Hospital Dr. Peset, Valencia.
14(6) 1992
Abstract Sedation is frequently required in children undergoing magnetic resonance imaging (MRI). 172 Paediatric patients (82 female and 90 male, age 42_+26 months, weight 14.7_+5.6 kg) entered an open, non-comparative, prospective study to assess the utilization of oral chloral hydrate. Chloral hydrate syrup (70 mg/ml) was administered 20-30 rain prior to the procedure. Effective sedation was reached in 80.3% with an average initial dose of 55 mg/kg and in 93.6% with an average total dose of 65 mg/kg. Significant differences in effectivity were correlated with the dose (54_+11 mg/kg in failure cases versus 66_+16 mg/kg in effective cases; p
