Korean J Anesthesiol.  2024 Oct;77(5):526-536. 10.4097/kja.24125.

Risk factors for chloral hydrate sedation failure in pediatric patients: a retrospective analysis

• Jang YE
• Park JB
• Kang P
• Ji SH
• Kim EH
• Lee JH
• Kim HS
• Kim JT

• KMID: 2559505
• DOI: http://doi.org/10.4097/kja.24125

Abstract

Background
This study aimed to investigate the risk factors for chloral hydrate sedation failure and complications in a tertiary children’s hospital in South Korea.
Methods
A retrospective analysis of pediatric procedural sedation with chloral hydrate between January 1, 2021, and March 30, 2022, was performed. The collected data included patient characteristics, sedation history, and procedure. Multivariable regression analysis was performed to identify the risk factors for procedural sedation failure and complications.
Results
A total of 6,691 procedural sedation were included in the analysis; sedation failure following chloral hydrate (50 mg/kg) occurred in 1,457 patients (21.8%) and was associated with a higher rate of overall complications compared to those with successful sedation (17.5% [225/1457] vs. 6.2% [322/5234]; P < 0.001, odds ratio: 3.236). In the multivariable regression analysis, the following factors were associated with increased risk of sedation failure: general ward or intensive care unit inpatient (compared with outpatient); congenital syndrome; oxygen dependency; history of sedation failure or complications with chloral hydrate; procedure more than 60 min; and magnetic resonance imaging, radiotherapy, or procedures with painful or intense stimuli (all P values < 0.05). Factors contributing to the complications included general ward inpatient, congenital syndromes, congenital heart disease, preterm birth, oxygen dependency, history of complications with chloral hydrate, and current sedation failure with chloral hydrate (all P values < 0.05).
Conclusions
To achieve successful sedation with chloral hydrate, the patient’s sedation history, risk factors, and the type and duration of the procedure should be considered.

Keyword

Chloral hydrate; Complications; Outside of the operating room; Pediatric patients; Procedural sedation; Sedation failure