A Comparison of the Efficacy and Safety of Chloral Hydrate Versus Inhaled Anesthesia for Sedating Infants and Toddlers for Transthoracic Echocardiograms

Nicolson, Susan C.; Montenegro, Lisa M.; Cohen, Meryl S.; O'Neill, Daniel; Calfin, Donna; Jones, Lisa A.; Jobes, David R.

doi:10.1016/j.echo.2009.11.019

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 1 , Pages 38-42, January 2010

A Comparison of the Efficacy and Safety of Chloral Hydrate Versus Inhaled Anesthesia for Sedating Infants and Toddlers for Transthoracic Echocardiograms

Susan C. Nicolson, MD
- Division of Cardiothoracic Anesthesia, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Correspondence: Susan C. Nicolson, MD, The Children's Hospital of Philadelphia, Division of Cardiothoracic Anesthesia, 34th Street and Civic Center Boulevard, Main Building, 12NW48, Philadelphia, PA 19104-4399.
Lisa M. Montenegro, MD
- Division of Cardiothoracic Anesthesia, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Meryl S. Cohen, MD
- Division of Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Daniel O'Neill, BA
- Division of Cardiothoracic Anesthesia, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Donna Calfin, RN
- Division of Cardiac Nursing, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Lisa A. Jones, BSN, RN
- Division of Cardiothoracic Anesthesia and Cardiac Critical Care, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
David R. Jobes, MD
- Division of Cardiothoracic Anesthesia, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Background

Pediatric patients may need sedation for a transthoracic echocardiogram. Due to the unpredictability and safety concerns with chloral hydrate, we offered mask anesthesia as an alternate strategy.

Methods

A retrospective chart review of 507 pediatric patients sedated for transthoracic echocardiography was conducted to compare the use of oral chloral hydrate (n = 297) with the face mask administration of sevoflurane anesthesia (n = 210).

Results

Anesthesia had a shorter time from administration of sedation to hospital discharge (112 vs 155 minutes), largely because of a shorter, more predictable, and less variable time to achieve satisfactory study conditions. Using anesthesia, an average 43-minute difference would allow for an additional procedure using the same resources. Anesthesia was not associated with sedation failure (0% vs 6%), and the duration of examination was shorter (40 vs 46 minutes). There were no significant adverse events in either cohort.

Conclusion

Anesthesia, although more costly, is balanced by more the efficient use of hospital and parental resources, with greater family and staff satisfaction.

Keywords: Pediatric, Sedation, Echocardiogram