RT Journal Article
SR Electronic
T1 Safety and efficacy of chloral hydrate for procedural sedation in paediatric ophthalmology: a systematic review and meta-analysis
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1423
OP 1430
DO 10.1136/bjophthalmol-2016-309449
VO 101
IS 10
A1 Asimina Mataftsi
A1 Paraskevi Malamaki
A1 Efthymia Prousali
A1 Paraskevi Riga
A1 Dimitrios Lathyris
A1 Nikolaos T Chalvatzis
A1 Anna-Bettina Haidich
YR 2017
UL http://bjo.bmj.com/content/101/10/1423.abstract
AB Purpose Although chloral hydrate (CH) has been used as a sedative for decades, it is not widely accepted as a valid choice for ophthalmic examinations in uncooperative children. This study aimed to systematically review the literature on the drug's safety and efficacy.Methods We searched PubMed, EMBASE, ISI Web of Science, Scopus, CENTRAL, Google Scholar and Trip database to 1 October 2015, using the keywords ‘chloral hydrate’, ‘paediatric’ and ‘procedural sedation OR diagnostic sedation’. A meta-analysis of randomised controlled trials (RCTs) was performed.Results A total of 6961 articles were screened and 104 were included in the review. Thirteen of these concerned paediatric ophthalmic examination, while 13 others were RCTs and were meta-analysed. CH was reported to have been administered in a total of 24 265 sedation episodes in children aged from <1 month to 18 years. The meta-analysis showed CH had a higher OR (2.95, 95% CI 1.09 to 7.99) for successful sedation compared to other sedatives, but significant limitations apply. The commonest reported adverse events (AE) were not serious (eg, paradoxical reaction or transient vomiting) and required no intervention. Severe AE, including two deaths, were related to comorbidity, overdose or aspiration.Conclusions Despite the paucity of high quality evidence, the existing literature suggests that the use of CH for procedural sedation in children appears to be an effective alternative to general anaesthesia, and it can be safe when administered in the hospital setting with appropriate monitoring and vigilance for intervention.