Sedating for the diagnosis of various diseases in children and therapeutic procedures has always been challenging 20. It seems to increase efficiency, and the method of relaxation should be associated with the reduction of anxiety and side effects in patients 21. Midazolam, diazepam, triazolam (benzodiazepines), chloral hydrate (aldehydes), thiopental (barbiturates), zolpidem (imidazoles pyridine derivatives z types), and ketamine (glutamate antagonists) are prescribed in the current clinical diagnostic and therapeutic procedures. Moreover, within these categories of sedatives, chloral hydrate, midazolam, dexmedetomidine are prescribed for sedation in children in the guideline 22. Chloral hydrate is recommended by the NICE 2010 guideline for children under 15 kg who are unable to tolerate a painless procedure had a wide margin of safety 23.
It has been reported that chloral hydrate adverse effects included respiratory depression, cardiac arrhythmias, motor imbalance, agitation, and local skin and mucosal lesions 24–27. But in our study, these adverse events occurred rarely. Our results indicated a high success rate for sedation and few complications and a low rate of adverse reactions for chloral hydrate sedation in infants that makes chloral hydrate a safe drug for sedation of children undergoing EEG.
In the present study, 94% of children in the nasal and 92% in the oral chloral hydrate group achieved a moderate level of sedation using an average dose of 55 mg/kg, successfully. These results were similar to what was reported where the majority of pediatric patients were successfully sedated using oral chloral hydrate 28.
Our results showed that pre and post-sedation heart rate was higher in the nasal spray than in the oral solution of chloral hydrate, however, hypoxemia, apnea, and oxygen supplementation were higher in the oral chloral hydrate group before the EEG procedure. Although hypoxia and apnea of intranasal chloral hydrate have not been reported so far, it has been shown that, similar to our results, the rates of hypoxia and apnea in the sedation of children with oral chloral hydrate were 5.9% and 0.3%, respectively 27. It has also been shown that during sedation with oral chloral hydrate, oxygen saturation decreased by 6% of children and required oxygen supplementation 29.
The mean procedure time, recovery time, and total nurse time were significantly lower in the nasal group compared to the oral chloral hydrate group. The average time for the nasal and oral chloral hydrate procedures was about 55 and 70 min, respectively. Our findings demonstrated that time efficacy was explained by the extremely rapid onset and short duration of action of the nasal spray. It has been shown that midazolam (0.5 mg/kg) compared to oral chloral hydrate (75 mg/kg) had a lower sedation success rate, a longer time to achieve sedation, a longer length of stay in the hospital, and a shorter sedation duration 30. Also, it has been reported that the averages time from oral administration of chloral hydrate to the onset of sedation was 15 to 60 min 31, 32.