DOCSLIB.ORG

Comparison of Chloral Hydrate with and Without Promethazine in the Sedation of Young Children

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparison of Chloral Hydrate with and Without Promethazine in the Sedation of Young Children PEDIATRICDENTISTRY/Copyright ©1985 by TheAmerican Academy of PediatricDentistry Volume7 Number1 Comparison of chloral hydrate with and without promethazine in the sedation of young children Milton I. Houpt, DDS, PhD Samuel R. Koenigsberg, DMD,MS Neil J. Weiss, DDS Paul J. Desjardins, DMD,PhD Abstract chloral hydrate effectiveness would be increased if supplemented with nitrous oxide. This study was performed to comparethe effectiveness of chloral hydrate with and without promethazine when This study compares chloral hydrate effectiveness young children were sedated for dental treatment. with and without promethzine together with nitrous Twenty-onechildren, participated in the study ranging in oxide when young children are sedated for dental age from 15 to 45 months with a meanage of 32 months. treatment. Subjects were assigned randomlyto receive either 75 mg! kg of chloral hydrate alone or 50 mg/kgtogether with 25 mg of promethazine; alternate regimens were Method administered at two appointments. (Eight children requiring three visits received 50 mg/kgchloral hydrate Subjects without promethazineat one visit. All children received Twenty-one children participated in the 50%nitrous oxide and were restrained in a Papoose study,ranging in age from 15 to 45 months with a Board® with head holder. The degree of sleep, crying, mean age of 32 months. The children were all in good body movements,blood pressure, pulse, respiration rate health, had no previous dental experience, and were and pupil size were evaluated before, during, and after selected because they required restorative dental operative procedures. Successful sedation, as evidenced by treatment with the use of sedation in at least two lack of crying and!or movementwhich interrupted appointments. treatment, was found in 89%of the children administered chloral hydrate and promethazine compared with 72% adminstered chloral hydrate alone. Vital signs remained Medication essentially unchangedthroughout all treatments. The At the first appointment, subjects randomly were only adverse side effect noted was vomiting in 14%of the assigned to receive either 75 mg/kg of chloral hydrate administrations with promethazine and 48%without. alone (Noctec a) or 50 mg/kg of chloral hydrate to- gether with 25 mg of promethazine (Phenergan For- Sedation is recommended frequently when ex- tisb); at the second appointment the alternate regimen was administered. Eight children requiring three vis- tensive dental treatment is performed for young chil- its received 50 mg/kg chloral hydrate without pro- dren. Chloral hydrate is used commonly because of methazine during one of the three visits. In addition, its wide margin of safety and relatively few adverse all children received 50%nitrous oxide/oxygen anal- side effects. 1 Numerousinvestigators have used dif- gesia and were restrained in a Papoose Board®c with ferent dosage regimens determined by behavior, age, 2"7 head holder. The chloral hydrate was drawn into a or weight; however, varying degrees of success were disposable syringe covered with tape to prevent the obtained. Some practitioners administer prometha- zine together with chloral hydrate to augment the a Noctec-Squibb Co.: Princeton, NJ. sedation effect and lessen the vomiting which may b Phenergan Fortis, Wyeth Laboratories: Philadelphia, PA. occur with chloral hydrate alone.l’8 Sim9 reported that c Papoose Board -- Olympic Medical Group: Seattle, WA. PEDIATRICDENTISTRY: March 19851Voi. 7 No. I 41 operator from knowing the amount of medication TABLE2. Rating Scale for Movement being given. Vital signs were recorded and behavior was eval- Violent movement uated by the operator. The child then was restrained interrupting treatment with his head tilted back over the lap of the seated Continuous movement operator and his arms held by a parent. The medi- makingtreatment cation was deposited in the back of the mouth in difficult amounts which allowed swallowing and prevented Controllable movement spitting. The soluti.on was squirted slowly, to avoid that doesnot interfere aspiration, and administration took approximately .5 with treatment min. The dosages of chloral hydrate ranged from 570 No movement mg to 1535 mg with a mean of 736 mg for those re- ceiving 50 mg/kg; and a mean of 1104 mg for those receiving 75 mg/kg. The amount of promethazine was TABLE3. RatingScale for Crying fixed at 25 mg. Subjects were treated consistently either during the Score Hystericalcrying that -- 1 morning or early afternoon so that treatment time demandsattention was constant for each subject. Similar types of treat- Continuous,persistent ment were planned for each of the treatment visits. crying that makestreatment Subjects were NPO6 hr before the appointment. difficult -- 2 Following drug administration, the child remained Intermittent, mild crying with the parent in a quiet area separated from the that doesnot interfere operatory for 45 rain; behavior and onset of sleep with treatment -- 3 (defined as closure of the eyes and lack of visible No crying -- 4 movement) were evaluated. The child then was car- fled® to the operatory and placed in a Papoose Board without auxiliary head restraint. A precordial steth- TABLE4. Rating Scalefor Overall Behavior oscope, abdominal pneumatic belt, sphygmomano- meter cuff, and finger pulse transducer were attached Aborted-- no treatment and then the nitrous oxide was administered. rendered Poor-- treatmentinterrupted, only partial treatment Evaluation completed The degree of sleep, body movement, crying, blood Fair -- treatmentinterrupted, pressure, pulse, respiration rate, and pupil size were but eventually all completed evaluated before, during, and after the operative pro- Good-- difficult, but all cedures. In the operatory, ratings were made during treatment performed mouth prop insertion, administration of the local Very good -- somelimited crying or movement,e.g., anesthesia, and every 15 min thereafter. Vital signs d during anesthesia or mouth were recorded with the Beckman R511A polygraph propinsertion unit. Rating scales were used to evaluate degree of Excellent- no crying or sleep, body movements, and crying (Tables 1, 2, 3). movement In addition, at the conclusion of each session, an overall evaluation of the child’s behavior was made according to a separate rating scale. (Table 4). These ratings were performed by the principal investigator the procedure. One month later, a consensus rating (MH) who was blind to the medication given during was made by two investigators (MH and SK) from video-tapes of the procedures to establish the reli- ability of the rating scales. TABLE1. RatingScale for Sleep Score Data Analysis Fully awake,alert -- 1 Drowsy,disoriented -- 2 The experiment was designed so that each subject Asleep -- 3 could serve as his own control with time of day, op- erator, and type of procedure being relatively con- stant. The independent variable was the drug regimen, d BeckmanInstruments: Somerset,NJ. that is, dose of chloral hydrate with and without pro- 42 CHLORALHYDRATE AND PROMETHAZINE SEDATION: Houpt et al. methazine. The dependent variable was the effec- of the time). The averages of the mean ratings over tiveness of sedation as measured by the degree of all the time periods for the three drug groups were crying and movement which interfered with treat- 3.53, 3.58, and 3.29. These were not statistically sig- ment. Since the rating scales used the ordinal scale nificantly different at the .05 level of significance (df of measurement with related samples, the nonpara- = 2, F = 0.25). metric Friedman two-way analysis of variance by ranks was used to compare the groups for statistically sig- Evaluation of Sleep nificant differences. In most instances, all subjects were asleep during the seven periods of evaluation. However, subjects Results were drowsy and disoriented 15% of the time, and subjects were fully awake 10%of the time. Subjects Rater Reliability who were awake most frequently were awake in the When the ratings of crying and movement made first 15 min in the operatory. There were no statisti- in the operatory were compared with the consensus cally significant differences between the various drug ratings of the two raters made one month later from groups at any single time period and no differences videotapes of the procedures, there was 90% agree- in the averages of the mean ratings over all time pe- ment between sets of ratings. riods (df = 2, F = 1.65). Onset of Sleep Overall Evaluation There was no significant difference in the onset of The summaryof the overall evaluations for all sub- sleep between the groups receiving different drug jects is illustrated in Table 7. Most subjects experi- regimens. Seventeen of the 21 patients who received enced either excellent or very good effects of the the 75 mg chloral hydrate without promethazine and sedation. The overall evaluation was only good 20% 16 of the 21 patients who received the medication of the time (i.e., the behavior was difficult, but all with promethazine fell asleep in the reception area, treatment was performed), and the effect of the se- that is, within 45 rain of receiving the chloral hydrate. dation was only fair 16%of the time (i.e., treatment Four of the 8 patients who received the 50 mg/kg had to be interrupted although it eventually was chloral hydrate alone fell asleep in the reception area. completed). The mean ratings for drug regimens 1, Consequently, 13 patients, or 26%of the total, were 2, and 3 were 4.71, 4.76, and 4.63, respectively, and fully awake when brought into the operatory. there were no statistically significant differences be- tween groups as indicated by the Friedman analysis Evaluation of Movement (df = 2, F = 0.71). Of those receiving the prometh- The summary of ratings of movement for all sub- azine, 90%had an overall evaluation of good or better jects in the operatory is illustrated in Table 5. In most as compared with 80% and 75% of those receiving instances, subjects exhibited no movementor mini- either the higher or lower dose of chloral hydrate mumcontrollable movement which interfered with alone.
Load more

Recommended publications
  • Analgesia and Sedation in Hospitalized Children
    Analgesia and Sedation in Hospitalized Children By Elizabeth J. Beckman, Pharm.D., BCPS, BCCCP, BCPPS Reviewed by Julie Pingel, Pharm.D., BCPPS; and Brent A. Hall, Pharm.D., BCPPS LEARNING OBJECTIVES 1. Evaluate analgesics and sedative agents on the basis of drug mechanism of action, pharmacokinetic principles, adverse drug reactions, and administration considerations. 2. Design an evidence-based analgesic and/or sedative treatment and monitoring plan for the hospitalized child who is postoperative, acutely ill, or in need of prolonged sedation. 3. Design an analgesic and sedation treatment and monitoring plan to minimize hyperalgesia and delirium and optimize neurodevelopmental outcomes in children. INTRODUCTION ABBREVIATIONS IN THIS CHAPTER Pain, anxiety, fear, distress, and agitation are often experienced by GABA γ-Aminobutyric acid children undergoing medical treatment. Contributory factors may ICP Intracranial pressure include separation from parents, unfamiliar surroundings, sleep dis- PAD Pain, agitation, and delirium turbance, and invasive procedures. Children receive analgesia and PCA Patient-controlled analgesia sedatives to promote comfort, create a safe environment for patient PICU Pediatric ICU and caregiver, and increase patient tolerance to medical interven- PRIS Propofol-related infusion tions such as intravenous access placement or synchrony with syndrome mechanical ventilation. However, using these agents is not without Table of other common abbreviations. risk. Many of the agents used for analgesia and sedation are con- sidered high alert by the Institute for Safe Medication Practices because of their potential to cause significant patient harm, given their adverse effects and the development of tolerance, dependence, and withdrawal symptoms. Added layers of complexity include the ontogeny of the pediatric patient, ongoing disease processes, and presence of organ failure, which may alter the pharmacokinetics and pharmacodynamics of these medications.
    [Show full text]
  • Toxicological Review of Chloral Hydrate (CAS No. 302-17-0) (PDF)
    EPA/635/R-00/006 TOXICOLOGICAL REVIEW OF CHLORAL HYDRATE (CAS No. 302-17-0) In Support of Summary Information on the Integrated Risk Information System (IRIS) August 2000 U.S. Environmental Protection Agency Washington, DC DISCLAIMER This document has been reviewed in accordance with U.S. Environmental Protection Agency policy and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use. Note: This document may undergo revisions in the future. The most up-to-date version will be made available electronically via the IRIS Home Page at http://www.epa.gov/iris. ii CONTENTS—TOXICOLOGICAL REVIEW for CHLORAL HYDRATE (CAS No. 302-17-0) FOREWORD .................................................................v AUTHORS, CONTRIBUTORS, AND REVIEWERS ................................ vi 1. INTRODUCTION ..........................................................1 2. CHEMICAL AND PHYSICAL INFORMATION RELEVANT TO ASSESSMENTS ..... 2 3. TOXICOKINETICS RELEVANT TO ASSESSMENTS ............................3 4. HAZARD IDENTIFICATION ................................................6 4.1. STUDIES IN HUMANS - EPIDEMIOLOGY AND CASE REPORTS .................................................6 4.2. PRECHRONIC AND CHRONIC STUDIES AND CANCER BIOASSAYS IN ANIMALS ................................8 4.2.1. Oral ..........................................................8 4.2.2. Inhalation .....................................................12 4.3. REPRODUCTIVE/DEVELOPMENTAL STUDIES ..........................13
    [Show full text]
  • Chloral Hydrate and Paraldehyde As Drugs of Addiction
    Sept., 1932J CHLORAL HYDRATE DRUG HABIT : CHOPRA & SINGH CHOPRA 481 certain parts of the Punjab. This is not the outcome of the use of the drug in the treatment Original Articles of insomnia, but is due to entirely different causes. Until a few years ago in that province potable country-made spirits were allowed to CHLORAL HYDRATE AND PARALDE' be sold to retail dealers in bulk and the vendors HYDE AS DRUGS OF ADDICTION bottled the liquor themselves. Some of these ingenious people conceived the idea of diluting R. N. m.d. By CHOPRA, m.a., (Cantab.) the spirit and adding small quantities of chloral I.M.S. LIEUTENANT-COLONEL, hydrate to make up for the loss in its potency and which would result from dilution. The know- GURBAKHSH SINGH CHOPRA, m.b., b.s. ledge that the drug had hypnotic and narcotic was obtained from the (Drug Addiction Inquiry, Indian Research Fund effects undoubtedly Association) medical profession and compounders work- in It was further learnt that Series No. 15 ing dispensaries. the effects chloral hydrate in many Chloral produced by hydrate and paraldehyde belong to resemble those by alcohol, the of ways produced group drugs known as soporifics or especially when the latter is taken in large The chief use of hypnotics. this class of drugs quantities. When the two articles are taken is in the treatment of one insomnia, of the together they act in a manner synergistic to worst evils of modern times from which man- each other and in this way the effect of either kind can suffer.
    [Show full text]
  • Halogenated Ether, Alcohol, and Alkane Anesthetics Activate TASK-3 Tandem Pore Potassium Channels Likely Through a Common Mechanism S
    Supplemental material to this article can be found at: http://molpharm.aspetjournals.org/content/suppl/2017/03/21/mol.117.108290.DC1 1521-0111/91/6/620–629$25.00 https://doi.org/10.1124/mol.117.108290 MOLECULAR PHARMACOLOGY Mol Pharmacol 91:620–629, June 2017 Copyright ª 2017 by The American Society for Pharmacology and Experimental Therapeutics Halogenated Ether, Alcohol, and Alkane Anesthetics Activate TASK-3 Tandem Pore Potassium Channels Likely through a Common Mechanism s Anita Luethy, James D. Boghosian, Rithu Srikantha, and Joseph F. Cotten Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.L., J.D.B., and J.F.C.); Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland (A.L.); Carver College of Medicine, University of Iowa, Iowa City, Iowa (R.S.) Received January 7, 2017; accepted March 20, 2017 Downloaded from ABSTRACT The TWIK-related acid-sensitive potassium channel 3 (TASK-3; hydrate (165% [161–176]) . 2,2-dichloro- . 2-chloro 2,2,2- KCNK9) tandem pore potassium channel function is activated by trifluoroethanol . ethanol. Similarly, carbon tetrabromide (296% halogenated anesthetics through binding at a putative anesthetic- [245–346]), carbon tetrachloride (180% [163–196]), and 1,1,1,3,3,3- binding cavity. To understand the pharmacologic requirements for hexafluoropropanol (200% [194–206]) activate TASK-3, whereas molpharm.aspetjournals.org TASK-3 activation, we studied the concentration–response of the larger carbon tetraiodide and a-chloralose inhibit. Clinical TASK-3 to several anesthetics (isoflurane, desflurane, sevoflurane, agents activate TASK-3 with the following rank order efficacy: halothane, a-chloralose, 2,2,2-trichloroethanol [TCE], and chloral halothane (207% [202–212]) .
    [Show full text]
  • Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial
    85 Emergency (2014); 2 (2): 85‐89 ORIGINAL RESEARCH Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial Reza Azizkhani1, Soheila Kanani1*, Ali Sharifi2, Keihan Golshani1, Babak Masoumi1, Omid Ahmadi1 1. Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2. Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran Abstract Introduction: The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia (PSA) to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced till now. The aim of the present study was comparison of oral chloral hydrate (OCH) and rectal sodium thiopental (RST) in pediatric PSA. Methods: In the present randomized clinical trial, 2‐6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH (50mg/kg) and RST (25mg/kg) were prescribed and a trained nurse recorded the time from drug prescription to receiving the con‐ scious sedation (onset of action), the total time period which the patient has the Ramsay score≥4 (duration of action), and adverse effect of agents. Mann‐Whitney U test and chi‐squared test, and Non‐parametric analysis of covariance (ANCOVA) were used for comparisons. Results: One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure (p<0.001). The onset of action in OCH and RST groups were 24.5±6.1and 28.7±5.2 minutes, respectively (p<0.001).
    [Show full text]
  • HS 172 R5/13 Briefly Review the Objectives, Content and Activities of This Session
    HS 172 R5/13 Briefly review the objectives, content and activities of this session. Upon successfully completing this session the participant will be able to: • Explain a brief history of the CNS Depressant category of drugs. • Identify common drug names and terms associated with this category. • Identify common methods of administration for this category. • Describe the symptoms, observable signs and other effects associated with this category. CONTENT SEGMENTS LEARNING ACTIVITIES A. Overview of the Category Instructor-Led Presentations B. Possible Effects Instructor Led Demonstrations C. OtdDtifEfftOnset and Duration of Effects RdiAiReading Assignmen ts D. Overdose Signs and Symptoms Video Presentations E. Expected Results of the Evaluation Slide Presentations F. Classification Exemplar HS 172 R5/13 9-2 • Explain the typical time parameters, i.e. onset and duration of effects, associated with this category. • List the clues that are likely to emerge when the drug influence evaluation is conducted for a person under the influence of this category of drugs. • Correctly answer the “topics for study” questions at the end of this session. HS 172 R5/13 9-3 A. Overview of the Category CNS Depressants Central Nervous System Depressants slow down the operations of the brain. Point out that other common names for CNS Depressants are “downers” and “sedative-hypnotics.” • Depressants first affect those arareaseas of the brain that control a person’ s conscious, voluntary actions. • Judgment, inhibitions and reaction time are some of the things that CNS Depressants affect first. • As the dose is increased, depressants begin to affect the parts of the brain that control the body’s automatic processes, heartbeat, respiration, etc.
    [Show full text]
  • Chloral Hydrate Safety Issues
    December 2016 www.nursingcenter.com Chloral Hydrate Safety Issues Chloral hydrate is a sedative-hypnotic that has been associated with serious adverse events in the pediatric population including dosing errors, over-sedation, and administration of the oral liquid by the intravenous (IV) route. In 2012, commercially available chloral hydrate products were discontinued and taken off the market. However, some ambulatory and hospital pharmacies are compounding an oral suspension of chloral hydrate for pediatric sedation in both inpatient and outpatient settings. Section 503A of the Federal Food, Drug and Cosmetic Act permits pharmacists to compound chloral hydrate to provide patient specific prescriptions in limited quantities. Compounded drugs are not approved by the US Food and Drug Administration (FDA), which means the FDA does not verify the safety or effectiveness of compounded drugs. One study found that compared to the commercial formulation, the compounded drug provided a shorter duration of sedation, more frequent need for an additional sedation agent, and frequent sedation failure. Over the last two years, there have been three reported cases of pediatric chloral hydrate overdoses and one death that occurred in the outpatient setting. Respiratory depression and arrest are two serious adverse events that can occur following chloral hydrate administration. Other risks associated with chloral hydrate use include: Resedation after discharge. Chloral hydrate can result in prolonged sedation or resedation with effects lasting longer than 24 hours in children of all ages, even if they appear to have cleared the sedation prior to discharge. Chloral hydrate is converted to trichloroethanol, which has a half-life of up to 66 hours in neonates, 28-40 hours in infants, 8-12 hours in children, and longer following an overdose.
    [Show full text]
  • Chloral Hydrate
    NTP TECHNICAL REPORT ON THE TOXICOLOGY AND CARCINOGENESIS STUDY OF CHLORAL HYDRATE (AD LIBITUM AND DIETARY CONTROLLED) (CAS NO. 302-17-0) IN MALE B6C3F1 MICE (GAVAGE STUDY) NATIONAL TOXICOLOGY PROGRAM P.O. Box 12233 Research Triangle Park, NC 27709 December 2002 NTP TR 503 NIH Publication No. 03-4437 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health FOREWORD The National Toxicology Program (NTP) is made up of four charter agencies of the U.S. Department of Health and Human Services (DHHS): the National Cancer Institute (NCI), National Institutes of Health; the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health; the National Center for Toxicological Research (NCTR), Food and Drug Administration; and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention. In July 1981, the Carcinogenesis Bioassay Testing Program, NCI, was transferred to the NIEHS. The NTP coordinates the relevant programs, staff, and resources from these Public Health Service agencies relating to basic and applied research and to biological assay development and validation. The NTP develops, evaluates, and disseminates scientific information about potentially toxic and hazardous chemicals. This knowledge is used for protecting the health of the American people and for the primary prevention of disease. The studies described in this Technical Report were performed under the direction of the NCTR and were conducted in compliance with NTP laboratory health and safety requirements and must meet or exceed all applicable federal, state, and local health and safety regulations. Animal care and use were in accordance with the Public Health Service Policy on Humane Care and Use of Animals.
    [Show full text]
  • Slipping a Mickey? Facts Around Drugs, Alcohol and Sexual Assault
    Slipping a Mickey? Facts around drugs, alcohol and sexual assault DR CATHY STEPHENSON OCTOBER 2011 Slipping a Mickey? Phrase coined in late 19th century Chicago barman Mickey Finn used “knock-out” drops to incapacitate and rob his patrons Probably used chloral hydrate Centuries old practise – other drugs in historical literature include alcohol, barbiturates and scopolamine Recently much media coverage of “date rape” drugs and “drink-spiking” Case 1 18 yo girl, seen 7 hours post sexual assault Party, 5 RTDs in 2.5 hours – left one open on the table Shortly after felt “strange” Taken home by friend’s father In car, forced oral and vaginal penetration Diazepam found on hair samples, but not urine Case 2 16 year old girl Seen 6 months after SA Risk-taking behaviour prompted disclosure ETOH + marijuana + antidepressant Much more common scenario Case 3 23 year old girl Seen 20 hours after sexual assault In town with friends Drinking Offered a ride home Raped in car outside her flat DFSA? Victims subjected to non-consensual sexual activity while they are incapacitated or unconscious through the effect of alcohol or drugs (1) Thereby prevented from resisting and unable to give consent Ingestion can be voluntary, involuntary or both DFSA may be “proactive” or “opportunistic”(2) So how often does it really happen? No reliable data in literature Reporting of SA in general very low 21% of females and almost 5% of males in Australia report a lifetime history of sexual coercion(3) Analysis of 1200 urine samples from sexual
    [Show full text]
  • Sedation in Fmri : an Unsolved Challenge
    Sedation in fMRI : An unsolved challenge Byron Bernal *, MD Nolan Altman**, MD There are many medications that can be utilized to sedate children undergoing fMR examinations. The most frequently used drugs are chloral hydrate, thiopenthal, phenobarbital, propofol, and fentanyl. These medications have some secondary effects on the electrical and metabolic activity of the cortex, cerebral blood flow(CBF), cerebral blood volume(CBV), and tissue oxygen extraction. These effects are of no concern in regular MRI (Magnetic Resonance Imaging), however, may have a significant contribution in fMR performed in the sedated child. Since fMRI is based on the hemodynamic and metabolic response of the brain to a given stimulus the selection of the sedation medication seems crucial. The following reviews the current knowledge regarding the relation of these drugs to these physiological parameters. Chloral Hydrate.- Chloral hydrate (CH) does not reduce brain cortex activity. This is demonstrated on EEG where it is widely used. Thoresen M and Henriksen O (1997) did not find changes on the EEGs in 9 out of 13 children with epileptic seizures, before and after CH was administered. We do not know of any reported studies relating CBF, CBV, or cerebral regional metabolism changes, and CH in humans. Propofol.- Propofol has been used as a sedative in children undergoing EEGs. Low propofol doses (0.5- 1 mg/kg) show an increase in the number of beta-waves and a significant reduction of alpha- and theta- waves . Larger doses of propofol (total dose of 2-2.5 mg/kg), the number of beta-waves decreased and delta-waves appeared.
    [Show full text]
  • Isoflurane, 2-Halogenated Ethanols, and Halogenated Methanes Activate TASK-3 Tandem Pore Potassium Channels Likely Through a Similar Mechanism
    Isoflurane, 2-Halogenated Ethanols, and Halogenated Methanes Activate TASK-3 Tandem Pore Potassium Channels Likely Through a Similar Mechanism. Authors: Joseph F. Cotten, M.D.,Ph.D1., Anita Luethy, M.D.1,2 1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. 2Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland. Background: TASK-3 (KCNK9) tandem pore potassium channel proteins mediate a constitutive potassium conductance activated by several clinically relevant volatile anesthetics (e.g., halothane, isoflurane, sevoflurane, and desflurane); knockout mice lacking the TASK-3 potassium channel are resistant to the hypnotic and immoblizing effects of halothane and isoflurane. Purpose: To better understand the molecular mechanism by which TASK-3 channels are activated by anesthetics, we studied the functional concentration-response of wild-type TASK-3 potassium channels to isoflurane, to ethanol, and to several halogenated ethanols and methanes. We also studied the concentration-response of M159W TASK-3 to 2,2,2- trichloroethanol; the M159W TASK-3 mutant is known to be resistant to isoflurane activation (1). 2,2,2-trichloroethanol, notably, is an active metabolite of the sedative chloral hydrate; and 2,2,2-tribromoethanol is the active ingredient in Avertin, an injectable veterinary anesthetic. Methods: Wild-type and M159W TASK-3 function were studied by Ussing chamber voltage clamp analysis during transient expression in Fischer rat thyroid cell monolayers. Results: 2-halogenated ethanols activate wild-type TASK-3 with the following rank order for efficacy: 2,2,2-tribromo > 2,2,2-trichloro > chloral hydrate > 2,2-dichloro > 2-chloro ≈ 2,2,2- trifluoro > ethanol (Table 1).
    [Show full text]
  • Chloral Hydrate: Summary Report
    Chloral Hydrate: Summary Report Item Type Report Authors Yuen, Melissa V.; Gianturco, Stephanie L.; Pavlech, Laura L.; Storm, Kathena D.; Yoon, SeJeong; Mattingly, Ashlee N. Publication Date 2020-02 Keywords Compounding; Food, Drug, and Cosmetic Act, Section 503B; Food and Drug Administration; Outsourcing facility; Drug compounding; Legislation, Drug; United States Food and Drug Administration; Chloral Hydrate Rights Attribution-NoDerivatives 4.0 International Download date 26/09/2021 09:06:16 Item License http://creativecommons.org/licenses/by-nd/4.0/ Link to Item http://hdl.handle.net/10713/12087 Summary Report Chloral Hydrate Prepared for: Food and Drug Administration Clinical use of bulk drug substances nominated for inclusion on the 503B Bulks List Grant number: 2U01FD005946 Prepared by: University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI) University of Maryland School of Pharmacy February 2020 This report was supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (U01FD005946) totaling $2,342,364, with 100 percent funded by the FDA/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, the FDA/HHS or the U.S. Government. 1 Table of Contents REVIEW OF NOMINATION ..................................................................................................... 4 METHODOLOGY ...................................................................................................................
    [Show full text]