• Neonatal Medicine
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• v.18 no.1
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• pp.130-136
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• 2011

Purpose: Chloral hydrate is a common drug frequently used for procedural sedation. But data on chloral hydrate use in the newborns are limited. This study examined the frequency of adverse effects of chloral hydrate and factors related to the adverse effects. We also examined if there were additional adverse effects when an additional sedative was used. Methods: The medical records of 104 patients admitted to neonatal intensive care unit of Seoul St. Mary's Hospital from March 2010 to February 2011 who used chloral hydrate for procedural sedation were retrospectively reviewed. Results: Adverse effects after administration of chloral hydrate were noted in 41.3% of the 104 patients. The adverse events included oxygen desaturation (18.8%), increase in apneic episodes (17.5%), increase in bradycardia (10%), and feeding intolerance (3.8%). Using oxygen at the time of chloral hydrate administration was independently associated with adverse effects (odds ratio [OR], 10.911: 95% confidence interval [CI], 2.082-57.178) and with the necessity for an additional sedative after administration of chloral hydrate (OR, 4.151: 95% CI, 1.455-11.840). Using one additional sedative agent after chloral hydrate showed no difference in adverse effects except feeding intolerance. Conclusion: Patients dependent on oxygen at the time of chloral hydrate administration may were found to be at higher risk for adverse effect of chloral hydrate and for an additional sedative. When an additional sedative is needed, it could be used with monitoring feeding intolerance after chloral hydrate administration.

• Journal of Korean Society of Environmental Engineers
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• v.30 no.2
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• pp.218-224
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• 2008

Coal-, coconut- and wood-based activated carbons and anthracite were tested to evaluate adsorption and biodegradation performances of chloral hydrate. In the early stage of the operation, the adsorption was the main mechanism for the removal of chloral hydrate, however as increasing populations of attached bacteria, the bacteria played a major role in removing chloral hydrate in the activated carbon and anthracite biofilter. It was also investigated that chloral hydrate was readily subjected to biodegrade. The coal- and coconut-based activated carbons were found to be most effective adsorbents in adsorption of chloral hydrate. Highest populations and activity of attached bacteria were shown in the coal-based activated carbon. The populations and activity of attached bacteria decreased in the order: coconut-based activated carbon > wood-based activated carbon > anthracite. The attached bacteria was inhibited in the removal of chloral hydrate at temperatures below 10$^{\circ}C$. It was more active at higher water temperatures(20$^{\circ}C$ <) but less active at lower water temperature(10$^{\circ}C$>). The removal efficiencies of chloral hydrate obtained by using four different adsorbents were directly related to the water temperatures. Water temperature was the most important factor for removal of chloral hydrate in the anthracite biofilter because the removal of chloral hydrate depended mainly on biodegradation. Therefore, the main removal mechanism of chloral hydrate by applying activated carbon was both adsorption and biodegradation by the attached bacteria. The observation suggests that the application of coalbased activated carbon to the water treatment should be the best for the removal of chloral hydrate.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.430-440
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• 2001

Orally administered chloral hydrate is often used, because of it's wide margin of safety and relatively few sideeffects. Hydroxyzine is an antihistamine with sedative and anti-emetic properties. It has been used in conjunction with chloral hydrate to reduce the incidence of nausea and vomiting. But, it's therapeutic drug concentration has not been established. The purpose of this study was to assess the sedative effect and physiologic parameter of hydroxyzine of different doses in sedating young pediatric dental patients. Fifty uncooperative children, mean age 33.2 months, who needed at least four separate restorative visits, requiring local anesthesia participated in this study. On every visit, one of the following 4 different sedative regimen was given (1) 70mg/kg CH (2) 70mg/kg CH and 1mg/kg HD (3) 70mg/kg CH and 2mg/kg HD (4) 70mg/kg CH and 3mg/kg HD. Physiologic parameter was recorded and behavior was videotaped and rated using Ohio State University Behavior Rating Scale by one investigator, blind to the dose. The analyzed sedative effect of combined oral administration of 70mg/kg chloral hydrate and 2mg/kg hydroxyzine was superior to the other regimens. Evidence of adverse effect was not detected or reported during and/or after the procedures.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.3
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• pp.455-462
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• 2002

Currently, the ages of the patients visiting dental hospital for dental care are becoming younger and the interest in the treatment for the handicapped and incapable of cooperation children increases. As a method for treatment of these patients, the sedation treatment is considered. A dental sedation using chloral hydrate and hydroxyzine of them were used widely and for a long time. In this study, the samples were consisted of incapable of cooperation or very young children required treatment of restoration under local anesthesia. Then, the vital signs were accessed in pediatric dental sedation using the combination of chloral hydrate and hydroxyzine. As a result of this study, the vital signs were little different in pediatric dental sedation using the combination of chloral hydrate and hydroxyzine. Simply, the respiration rate and pulse rate decreased according to sleeping of patients. Therefore, the sedation using the combination of chloral hydrate and hydroxyzine induced to appropriate sedation in incapable of cooperation or very young children with little effects of vital signs.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.4
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• pp.489-497
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• 2002

The purpose of this study was to compare the clinical sedation effect of chloral hydrate and hydroxyzine combination with and without nitrous oxide/oxygen inhalation when young children were sedated for dental treatment. The uncooperative 20 children aged, 21 to 47 months of age(ASA Class I), participated in the study. The author examined 20 children(male 12, female 8). Each patient was assigned to receive chloral hydrate(50mg/kg) and hydroxyzine(25mg). Next appointment, each patient was assigned to receive $N_2O-O_2$, choral hydrate and hydroxyzine. Sleep, crying, movement, and overall behavior response were evaluated, and the sedative effects were evaluated by Houpt's rating scale. Pulse rate and peripheral oxygen saturation were also measured for monitoring the sedated patients during treatment period by pulse oximeter. The result were as follows : 1. In the evaluation of sleep scores, crying scores, and movement scores, chloral $hydrate/hydroxyzine/N_2O-O_2$ combination group was significantly rated high(p<0.05). 2. In the evaluation of overall behavior scores, chloral hydrate/hydroxyzine/$N_2O-O_2$ combination group was significantly rated high(p<0.05). 3. In the evaluation of overall behavior evaluation scores(by Houpt), 93.3% in chloral $hydrate/hydroxyzine/N_2O-O_2$ combination group and 63.3% in chloral hydrate/hydroxyzine combination group were rated "good" or "very good". 4. There was no adverse side effect(i.e. respiratory depression) in both group.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.811-824
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• 1998

The purpose of this study was to compare the clinical sedation effect of chloral hydrate and hydroxyzine combination, midazolam, triazolam when young children were sedated for dental treatment. The uncooperative 22 children aged, 25 to 52 months of age(ASA class I) and weighting between 11 and 17kg, participated in the study. Each patient was assigned randomly to receive chloral hydrate(50mg/kg) and hydroxyzine HCl(25mg), midazolam(0.5mg/kg), and triazolam(0.25mg) oral administration : alternative regimens were administered at next appointment. According to rating scale, sleep, crying, movement, and overall behavior response were checked for evaluation of the clinical sedation effect. Pulse rate and oxygen saturation were also measured for monitoring the patients during treatment period by pulse oximeter. The results were as follows: 1. In the evaluation of sedation effect, 90.9% in chloral hydrate and hydroxyzine combination and midazolam, and 77.3% in triazolam were rated "good" or "very good". 2. Sleep was demonstrated to be statistically significant increase in chloral hydrate and hydroxyzine combination group. Despite the fact that chloral hydrate and hydroxyzine group was in a deeper state of sleep, all the children were easily aroused. 3. There were no statistically significance among the three regimens with regard to cry ing, movement, overall behavior. 4. The adverse side effect was vomiting in one patient of chloral hydrate and hydroxyzine combination. There were no clinical sign of respiratory depression.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.2
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• pp.262-269
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• 2005

The purpose of this study was to compare the efficacy and complications of two oral sedative regimens, chloral hydrate (60mg/kg)/hydroxyzine(25mg) versus midazolam(1mg/kg)/meperidine(1mg/kg) for the sedation of pediatric dental patients. Fifteen patients(mean age 36.2months, range 24-47months), ASA Class I or II, who needed at least two restorative dental procedures were selected in this double-blind, randomized study. All subjects were randomly assigned to receive either chloral hydrate/hydroxyzine or midazolam/meperidine and 50% $N_2O/O_2$ was administered at each appointment. Behavior assessment(sleep, movement, crying, overall behavior) was made using Houpt Sedation Rating Scale and physiologic parameters(pulse rate, oxygen saturation) were monitored using pulse oximeter. The incidence of hypoxia($SpO_2$ 90% or less, at least 10s duration) and vomiting was recorded. Patients sedated with chloral hydrate/hydroxyzine showed significantly better overall behavior score than patients sedated with midazolam/meperidine. There was no clinically significant difference in the incidence of hypoxia and vomiting. It was concluded that oral administration of chloral hydrate/hydroxyzine is more effective than midazolam/meperidine for the sedation of pediatric dental patients.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.107-118
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• 2020

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords "dental sedation," "chloral hydrate," and "children or adolescent," 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.1
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• pp.280-292
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• 1997

The purpose of this study was to assess the sedative effect of three kinds of medication for management of the uncooperative 60 children aged from 16 months to 87 months required extensive treatment. The patients were given randomly a dose of 75mg/kg of chloral hydrate and hydroxyzine 25mg orally or 0.5mg/kg of midazolam orally or 0.3mg/kg of midazolam intranasally. All the children were restrained in a Pediwrap and were monitored with Pulse oximeter for assessing the safety of patients. According to rating scale, sleep, crying, movement, and overall behavior were checked for evaluation of the clinical sedative effect. The results were as follows: 1. In the evaluation of sleep, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05). 2. In the evaluation of crying and movement at beginning of treatment, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05), but during the treatment, rating scale of each group was not significantly different (p>0.05). 3. In the evaluation of overall behavior, 80% children of chloral hydrate/hydroxyzine were rated good or very good. With the oral and intranasal midazolam, 60% children were rated good or very good respectively. 4. There were no clinical signs of significant cyanosis and respiratory depression. Clinically, chloral hydrate/hydroxyzine was proved to be more effective sedation than any other sedative method. Oral and intranasal midazolam were also safe and effective sedation in young children undergoing pediatric dental procedures.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.337-344
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• 2001

The combination of chloral hydrate and hydroxyzine is one of the safest and most commonly used drug regimens for sedating young, uncooperative pediatric dental patients. The continuous monitoring of respiratory function and early recognition of respiratory difficulties are essential for the successful management of sedated dental patients. The purpose of this study was to evaluate the success rate of the sedation and the hypoxia through monitoring the oxygen desaturation in the pulse oximeter in pediatric dental patients sedated with 60mg/kg chloral hydrate and 25mg hydroxyzine. The following results were obtained : 1. The success rate of the sedation was 69.6% and there was no statistically significant difference among the groups based on the ages, weight and duration of the operative time. 2. Forty two percentage of the sedated patients showed the temporary hypoxia state and there was no statistically significant difference based on the ages and weights of the patients. But there was a statistically significant difference on the duration of the operative time.