Cochrane · systematic review · CD011786
Chloral hydrate as a sedating agent for neurodiagnostic procedures in children
Fong, CY, Lim, WK, Li, L, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
63
current version
GRADE rated
46
No studies
17
Included studies
NR
No studies 17 · 27%Ungraded 0 · 0%Very low 6 · 9.5%Low 18 · 28.6%Moderate 20 · 31.7%High 2 · 3.2%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsChloral hydrate oral (50 mg/kg or 100 mg/kg) compared to dexmedetomidine oral (2 µg/kg or 3 µg/kg) as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | no estimate extracted | 1 study · 160 participants | Moderate Downgraded: risk of bias |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | RR 1.14 [0.51, 2.53] | 1 study · 160 participants | Moderate Downgraded: imprecision |
Sedation duration (minutes) Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | no estimate extracted | 1 study · 160 participants | Moderate Downgraded: imprecision |
Number of children with clinical adverse events (any) Chloral hydrate oral (50 mg/kg or 100 mg/kg) vs dexmedetomidine oral (2 µg/kg or 3 µg/kg) | RR 7.66 [1.78, 32.91] | 1 study · 160 participants | Low Downgraded: imprecision |
Chloral hydrate oral (75 mg/kg) compared to pentobarbital intravenous (5 mg/kg) as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | no estimate extracted | 1 study · 70 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who had sedation failure after 1 dose of sedative agent Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | RR 4.33 [1.35, 13.89] | 1 study · 70 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who had sedation failure after 2 doses of sedative agent (same or different) Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | RR 3 [0.33, 27.46] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Non‐interpretable neuroimaging finding Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | RR 0.23 [0.03, 1.94] | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision |
Number of children with clinical adverse event: oxygen desaturation Chloral hydrate oral (75 mg/kg) vs pentobarbital intravenous (5 mg/kg) | RR 0.67 [0.21, 2.16] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Chloral hydrate oral (100 mg/kg or 75 mg/kg) compared to midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | no estimate extracted | 1 study · 60 participants | Moderate Downgraded: imprecision, inconsistency |
Proportion of children with inadequate level of sedation (Ramsay score below 4) Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | RR 0.11 [0.03, 0.44] | 1 study · 60 participants | Moderate Downgraded: imprecision, inconsistency |
Proportion of children who had sedation failure after 1 dose of sedative agent Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | RR 0.17 [0.02, 1.12] | 1 study · 33 participants | Low Downgraded: imprecision |
Sedation duration (minutes) Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | no estimate extracted | 1 study · 33 participants | Low Downgraded: imprecision |
EEG sedative‐induced artefact Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | RR 0.58 [0.44, 0.76] | 1 study · 198 participants | High |
Number of children with clinical adverse events (any) Chloral hydrate oral (100 mg/kg or 75 mg/kg) vs midazolam (intranasal 0.2 mg/kg or oral 0.5 mg/kg) | RR 0.2 [0.01, 4.2] | 1 study · 198 participants | Low Downgraded: imprecision |
Chloral hydrate oral (50 mg/kg) compared to melatonin oral as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (50 mg/kg) vs melatonin oral | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (50 mg/kg) vs melatonin oral | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (50 mg/kg) vs melatonin oral | no estimate extracted | NR | No studies |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (50 mg/kg) vs melatonin oral | no estimate extracted | NR | No studies |
EEG sedative‐induced artefact Chloral hydrate oral (50 mg/kg) vs melatonin oral | RR 0.33 [0.14, 0.82] | 1 study · 348 participants | Low Downgraded: risk of bias, imprecision |
Number of children with clinical adverse events (any) Chloral hydrate oral (50 mg/kg) vs melatonin oral | RR 1 [0.25, 3.93] | 1 study · 348 participants | Low Downgraded: risk of bias, imprecision |
Chloral hydrate oral (50 mg/kg + 50 mg/kg) compared to hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | no estimate extracted | NR | No studies |
TIme to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | no estimate extracted | 1 study · 282 participants | Moderate Downgraded: risk of bias |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | RR 0.33 [0.11, 1.01] | 1 study · 282 participants | Low Downgraded: risk of bias, imprecision |
Sedation duration (minutes) Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | no estimate extracted | 1 study · 282 participants | Moderate Downgraded: risk of bias |
Number of children with clinical adverse event: behavioural change Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | RR 1.17 [0.4, 3.38] | 1 study · 282 participants | Low Downgraded: risk of bias, imprecision |
Number of children with clinical adverse event: nausea or vomiting Chloral hydrate oral (50 mg/kg + 50 mg/kg) vs hydroxyzine hydrochloride oral (1 mg/kg + 1 mg/kg) | RR 1.25 [0.34, 4.56] | 1 study · 282 participants | Low Downgraded: risk of bias, imprecision |
Chloral hydrate oral (70 mg/kg) compared to promethazine oral (1 mg/kg) as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | no estimate extracted | 1 study · 60 participants | Moderate Downgraded: imprecision, inconsistency |
Proportion of children with inadequate level of sedation (Ramsay score below 4) Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | RR 0.03 [0, 0.45] | 1 study · 60 participants | Low Downgraded: imprecision |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | RR 0.11 [0.01, 0.82] | 1 study · 60 participants | Moderate Downgraded: imprecision, inconsistency |
Number of children with clinical adverse event: behavioural change Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | RR 0.2 [0.01, 4] | 1 study · 60 participants | Moderate Downgraded: imprecision, inconsistency |
Number of children with clinical adverse event: vomiting or nausea Chloral hydrate oral (70 mg/kg) vs promethazine oral (1 mg/kg) | RR 13 [0.76, 220.96] | 1 study · 60 participants | Low Downgraded: imprecision |
Chloral hydrate oral (60 mg/kg) compared to music therapy as sedating agents for neurodiagnostic procedures in children
Population: children undergoing neurodiagnostic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (60 mg/kg) vs music therapy | no estimate extracted | NR | No studies |
Proportion of children who required a further dose of either the same sedative agent or the addition of a different sedative agent Chloral hydrate oral (60 mg/kg) vs music therapy | no estimate extracted | NR | No studies |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (60 mg/kg) vs music therapy | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (60 mg/kg) vs music therapy | RR 17 [2.37, 122.14] | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision |
Sedation duration (minutes) Chloral hydrate oral (60 mg/kg) vs music therapy | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision |
Number of children with clinical adverse events (any) Chloral hydrate oral (60 mg/kg) vs music therapy | no estimate extracted | NR | No studies |
Chloral hydrate oral (50 mg/kg) compared to sodium thiopental rectal (25 mg/kg) for neurodiagnostic procedures in children
Population: neurodiagnostic procedures in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who successfully completed neurodiagnostic procedure without interruption by the child awakening Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | RR 0.95 [0.83, 1.09] | 1 study · 140 participants | Moderate Downgraded: imprecision |
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | no estimate extracted | 1 study · 140 participants | Moderate Downgraded: imprecision |
Proportion of children who had sedation failure or inadequate level of sedation Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | RR 1.33 [0.6, 2.96] | 1 study · 140 participants | Moderate Downgraded: imprecision |
Sedation duration (minutes Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | no estimate extracted | 1 study · 140 participants | Moderate Downgraded: imprecision |
Number of children with clinical adverse event: desaturation Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | RR 5 [0.24, 102.3] | 1 study · 140 participants | Low Downgraded: imprecision |
Number of children with clinical adverse event: diarrhoea Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | RR 0.04 [0, 0.72] | 1 study · 140 participants | Moderate Downgraded: imprecision |
Mean diastolic blood pressure during procedure (mmHg) Chloral hydrate oral (50 mg/kg) vs sodium thiopental rectal (25 mg/kg) | no estimate extracted | 1 study · 140 participants | Moderate |
Chloral hydrate oral (50 mg/kg) compared to clonidine oral (4 μg/kg) for neurodiagnostic procedures in children
Population: neurodiagnostic procedures in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) (minutes) Chloral hydrate oral (50 mg/kg) vs clonidine oral (4 μg/kg) | no estimate extracted | 1 study · 198 participants | Low Downgraded: risk of bias |
Sedation duration (minutes) Chloral hydrate oral (50 mg/kg) vs clonidine oral (4 μg/kg) | no estimate extracted | 1 study · 198 participants | Low Downgraded: risk of bias |
Number of children with clinical adverse event: drowsiness Chloral hydrate oral (50 mg/kg) vs clonidine oral (4 μg/kg) | RR 0.44 [0.3, 0.64] | 1 study · 198 participants | Moderate Downgraded: risk of bias |
Number of children with clinical adverse event: vertigo Chloral hydrate oral (50 mg/kg) vs clonidine oral (4 μg/kg) | RR 0.15 [0.01, 2.79] | 1 study · 198 participants | Moderate Downgraded: risk of bias |
Chloral hydrate oral (50 mg/kg) compared to dexmedetomidine intranasal (3 μg/kg) for neurodiagnostic procedures in children
Population: neurodiagnostic procedures in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to adequate sedation (minutes or as measured by specific validated scales such as the Ramsay Sedation Score) (minutes) Chloral hydrate oral (50 mg/kg) vs dexmedetomidine intranasal (3 μg/kg) | no estimate extracted | 1 study · 194 participants | Moderate |
Number of children with clinical adverse event: bradycardia Chloral hydrate oral (50 mg/kg) vs dexmedetomidine intranasal (3 μg/kg) | RR 0.17 [0.05, 0.59] | 1 study · 194 participants | High |
Number of children with clinical adverse event: unsteadiness within 24 h after discharge Chloral hydrate oral (50 mg/kg) vs dexmedetomidine intranasal (3 μg/kg) | RR 10.21 [0.58, 178.52] | 1 study · 173 participants | Low Downgraded: imprecision |
Number of children with clinical adverse event: crying during administration of sedation Chloral hydrate oral (50 mg/kg) vs dexmedetomidine intranasal (3 μg/kg) | RR 1.39 [1.08, 1.8] | 1 study · 194 participants | Moderate |
Number of children with clinical adverse event: vomiting Chloral hydrate oral (50 mg/kg) vs dexmedetomidine intranasal (3 μg/kg) | RR 10.59 [0.61, 185.45] | 1 study · 194 participants | Low Downgraded: imprecision |