A comparison of oral diazepam versus midazolam,administered with intravenous meperidine,as premedication to sedation for pediatric endoscopy

OBJECTIVES: This study was performed to compare the effects of oral midazolam and oral diazepam, administered with intravenous (IV) meperidine, on pre-procedural, procedural, and post-procedural sedation and recovery in children undergoing diagnostic upper endoscopy. The costs of pre-procedure sedation were compared for the two benzodiazepines. METHODS: A randomized, double-blind study was conducted in 154 children (mean age 96.73 +/- 59.34 months, 53% male) undergoing endoscopy. Oral midazolam (0.5 mg/kg, maximum dose of 20 mg) or oral diazepam (0.3 mg/kg, maximum dose of 10 mg) was given before IV insertion, and with IV meperidine (2 mg/kg, maximum dose of 100 mg) given to all patients just before upper endoscopy. Further "rescue" midazolam doses (to a maximum cumulative dose of 5 mg) were given as needed to achieve a pre-procedure sedation score of > or =2. All patients received intravenous propofol for procedural sedation. Patients were evaluated for the efficacy and safety of pre-procedural sedation, sedation during upper endoscopy, and recovery following completion of the procedure. RESULTS: There were no significant differences between study groups for level of pre-procedural sedation, need for midazolam rescue in endoscopy, effectiveness of procedural sedation, occurrence of adverse events, and recovery parameters. CONCLUSIONS: Oral midazolam and diazepam, in conjunction with IV administration of meperidine, provide comparable, effective, and safe premedication for children undergoing upper endoscopy. The cost of midazolam was substantially higher than diazepam.     

Comparison of Oral and Buccal Midazolam for Pediatric Dental Sedation: A Randomized,Cross-Over,Clinical Trial for Efficacy,Acceptance and Safety

Objective

Providing a safe and efficient dental treatment for a young patient is a challenge for the dentist and the child. The purpose of this study was to investigate the effectiveness, safety and acceptability of buccal midazolam in dental pediatric patients and to compare it with oral Midazolam.

Methods

Eighteen uncooperative healthy children aged 2.5-6 years were randomized to each of buccal midazolam (0.3mg/kg) or oral midazolam (0.5mg/kg) at the first visit, the alternative has been used at the second visit in a cross-over manner. The study took place at pediatric dentistry clinic of Shahed University, Tehran, from November 2011 to June 2012. The patients‘ vital signs and behavioral scores were recorded. The patient, the operator and the observer were blinded to the applied medication. Post operatively, patients‘ and parents‘ satisfaction were assessed by Visual Analogue Score and a questionnaire respectively. The P-value was set at 0.05 for significance level.

Findings

There were no significant differences in physiologic factors in the medication groups at time 0, 10, 20, 30 minutes and discharge. There was also no significant difference between the two groups in behavioral parameters. The majority of parents rated both sedative agents as “effective” or “very effective” and their children mostly were without anxiety or with minor anxiety.

Conclusion

Buccal midazolam may be safely and efficiently used in sedation of pediatric dental patients.     

Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study

OBJECTIVES: The primary objective of the present study was to compare the required dose of intravenous (IV) propofol between group A (synergistic sedation with an oral dose of midazolam combined with IV propofol) and group B (IV propofol alone), in diagnostic upper gastrointestinal endoscopy (UGIE) in pediatric patients. The secondary objective was to compare the safety, the efficacy, the ease of IV line placement and the ease of separation from parents between the 2 groups. METHODS: Fifty-four consecutive children (aged 3 y or older) who underwent UGIE were randomly assigned to 1 of the 2 medication regimens. Patients in group A (n = 26, mean age: 8.1 y) received midazolam (0.5 mg/kg) orally. Thirty minutes after the midazolam dose was given, repeated IV doses of propofol 0.5 mg/kg were administered titrated to achieve the level of deep sedation. Patients in group B (n = 28, mean age: 9 y) received IV propofol alone with the same methodology and sedation end point. RESULTS: The mean dose (1.8 +/- 0.7 mg/kg) of propofol administered in group A patients was remarkably lower compared with that (2.9 +/- 0.9 mg/kg) of group B. Multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, the synergistic sedation was the only factor associated with the ease of IV line placement (chi(2) = 16.3, P < 0.001) and the ease of separation from parents (chi(2) = 41.6, P < 0.001). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, synergistic sedation was the only factor associated with a higher level of patient comfort (chi(2) = 35.5, P < 0.001). The recovery time was significantly shorter in group B patients (7.7 +/- 3.6 min) compared with that of group A (25.9 +/- 4.1 minutes) (P < 0.01). The 2 regimens were equally safe. CONCLUSIONS: Our data suggest that synergistic sedation with an oral dose of midazolam combined with propofol may benefit the children who undergo UGIE with regard to lower mean dose of propofol used, easier IV line placement, easier separation from the parents, less pain induced by the IV line placement and greater patient comfort.     

Sedation for peritonsillar abscess drainage in the pediatric emergency department

OBJECTIVE: To evaluate the use of intravenous (IV) sedation in children during peritonsillar abscess (PTA) incision and drainage in the emergency department (ED). DESIGN: Retrospective review of medical records of children with a diagnosis of PTA. SETTING: The ED of a large, urban, academic children's hospital. PATIENTS: Consecutive patients 18 years or younger presenting from April 1995 to November 1998. METHODS: Information was retrieved from a time-based sedation record that included age, sex, ASA classification, time since last liquid or solid, agent and dose, level of sedation (A=alert, V=response to voice, P=purposeful response to pain, U=unresponsive), vital signs, complications, recovery time, and disposition. RESULTS: Forty-two patients had incision and drainage performed with IV sedation in the ED. Mean age was 11.3 +/- 4.3 years (range 4-18 years); 57% were African-American, and 64% were female. Agents used included ketamine plus midazolam (K/M) (n = 36, 86%), morphine plus midazolam (n = 3, 7%), meperidine plus midazolam (n = 2, 5%), and nitrous oxide plus midazolam (n = 1, 2%). No cardiorespiratory complications, including laryngospasm, occurred. Vomiting occurred in 1 patient who received meperidine and midazolam. The deepest level of sedation reached included: 12% A, 64% V, and 24% P. No patient who had an abscess drained in the ED with IV sedation was admitted, and mean recovery time was 81.0 +/- 30.1 minutes. CONCLUSIONS: IV sedation in children for incision and drainage of PTA by skilled personnel in the ED may eliminate the need for admission and surgical drainage in the operating room. K/M was used most frequently, without adverse effect, and all patients were discharged from the ED. Because K/M may result in deep sedation, appropriate personnel and equipment must be present.     

Trends in Visits and Costs for Mental Health Emergencies in a Pediatric Emergency Department, 2010–2016

ObjectiveAnalyze trends in visit numbers, length of stay (LOS), and costs of pediatric mental health emergency department (ED) visits over time.MethodsWe conducted a cross-sectional, time-series analysis from 2010 to 2016 of mental health visits, identified by billing diagnosis codes, among children 5 to 18years old in a tertiary pediatric ED. We used Poisson regression to analyze trends in rates of mental health visits, patient-hours, and visits with LOS ≥ 24hours. We used time-series analysis to trend median costs per visit.ResultsFrom 2010 to 2016, there were 197,982 ED visits and 13,367 (6.7%) mental health visits. Mental health visits increased by 45% (from 1462 to 2119), compared to a 13% increase in non–mental health visits. The rate of mental health visits increased from 5.6 to 7.1 per 100 ED visits and increased 5.5% annually, compared to –0.4% annually for non–mental health visits (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.05–1.07). Mental health patient-hours increased 186%, compared to an 18% increase in non–mental health patient-hours. The rate of mental health visits with LOS ≥ 24hours increased from 4.3 to 18.8 per 100 mental health visits and increased 22% annually (IRR, 1.22; 95% CI, 1.19–1.26). Median costs per visit increased by $38 per quarter (95% CI, $28–$48).ConclusionsRates of mental health visits, patient-hours, visits with LOS ≥ 24hours, and visit costs are increasing over time. Additional hospital and community resources are needed to address rising ED utilization for mental illness in children.     

Use of oral midazolam in pediatric upper gastrointestinal endoscopy

Background: The purpose of this prospective, randomized study was to compare the safety and efficacy of oral versus i.v. midazolam in providing sedation for pediatric upper gastrointestinal (GI) endoscopy. Methods: Sixty‐one children (age <16 years) scheduled for upper GI endoscopy were studied. Patients were randomly assigned to receive oral or i.v. midazolam. Measurements were made and compared for vital signs, level of sedation, pre‐ and post‐procedure comfort, anxiety during endoscopy, ease of separation from parents, ease and duration of procedure, and recovery time. Results: Patients were aged 1–16 years (mean 7.5 ± 3.42 years); 30 patients received oral medication, and 31 received i.v. medication. There were no statistically significant differences in age or gender between groups. There were no significant differences in level of sedation, ease of separation from parents, ease of ability to monitor the patient during the procedure, heart rate, systolic arterial pressure, or respiratory rate. Oxygen saturation was significantly lower in the i.v. group than the oral group 10 and 30 min after removal of the endoscope, and recovery time was longer in the oral than the i.v. group. Conclusions: Oral administration of midazolam is a safe and effective method of sedation that significantly reduces anxiety and improves overall tolerance for children undergoing esophagogastroduodenoscopy.     

Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children

Background Various strategies to mitigate children’s distress during voiding cystourethrography (VCUG) have been described. Sedation with nitrous oxide is comparable to that with oral midazolam for VCUG, but a side-by-side comparison of nitrous oxide sedation and routine care is lacking. Objective The effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared. Materials and methods A sample of 204 children 4–18 years of age scheduled for VCUG or RNC with sedation or routine care were enrolled in this prospective study. Nitrous oxide/oxygen (70%/30%) was administered during urethral catheterization to children in the sedated group. The outcomes recorded included observed distress using the Brief Behavioral Distress Score, self-reported pain, and time in department. Results The study included 204 patients (99 nonsedated, 105 sedated) with a median age of 6.3 years (range 4.0–15.2 years). Distress and pain scores were greater in nonsedated than in sedated patients (P < 0.001). Time in department was longer in the sedated group (90 min vs. 30 min); however, time from entry to catheterization in a non-imaging area accounted for most of the difference. There was no difference in radiologic imaging time. Conclusion Sedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children.     

Psychosomatic, sedative and hemodynamic reactions following preoperative administration of midazolam in children

Since children's intellectual perception is limited, the preoperative visit by an anesthesiologist alone can rarely help to free the small patients from fear and restlessness prior to elective surgery. In order to relieve anxiety which should be the primary goal of premedication in any patient - children need anxiolytic premedication agents. Drugs for premedication administered by intramuscular or rectal route in children often cause pain, fear and discomfort. The present study was performed in order to investigate oral given midazolam in the premedication of children with special regard to the practical suitability of this method. 100 children, 0.5 to 10 years of age (group A: 0.5-4 years, group B: 5-10 years) undergoing elective urological surgery received 0.4 mg/kg midazolam orally about 20 minutes prior to the arrival in the operation unit. After insertion of a venous cannula into a forearm vein anesthesia was induced with thiopental and maintained by inhalation with Isoflurane, nitrous oxide and oxygen (fi O2:0.3). Degree of sedation, state of mind and behaviour (for 100 children) as well as blood pressure and heart rate (separately for group A and B) were registered preoperatively at defined, comparable and representative circumstances. Side effects prior and during induction phase of anesthesia were documented. The personal data are representative for a normal population of children with typical urological diseases. Oral administered midazolam had only a mild or non sedative effect in 76-84% of the children 70-84% of the small patients showed an indifferent or euphoric state of mind and 67-88% behaved cooperatively or passively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pharmacokinetic and pharmacodynamic study of midazolam in children during esophagogastroduodenoscopy

We undertook a prospective study to evaluate the relationship between the onset and degree of sedation and the midazolam plasma concentration in children between 6 and 18 years of age during esophagogastroduodenoscopy. Thirteen boys and seven girls (median age 13.5 years) were studied. Midazolam was injected intravenously for 5 minutes, and the dose was titrated to sedation or a maximum dose of 0.1 mg/kg was given. Plasma midazolam concentration was determined just before and at 5, 10, 15, 30, 45, and 60 minutes after the start of midazolam injection. The patient's level of sedation was evaluated by an assistant at each blood sampling time. Clearance, volume of distribution, and terminal elimination (beta) half-life were estimated from a biexponential fit of the serial plasma midazolam concentrations. Mean beta half-life of midazolam was 47 +/- 26 minutes and mean clearance was 10.0 +/- 5.0 ml/min per kilogram of body weight. Maximum level of sedation occurred at 5 minutes after initiation of the injection and corresponded to a mean peak midazolam serum concentration of 229 +/- 39 micrograms/L. Thereafter, a decline of mean sedation scores paralleled the decrease in midazolam concentration. Mean oxygen saturation remained greater than 94% during the study. We conclude that children metabolize and excrete midazolam more rapidly than adults do and that sedation adequate for endoscopy is safely achieved in the majority of children with a midazolam dose of 0.05 to 0.1 mg/kg and a mean peak midazolam concentration greater than 200 microgram/L.     

Conscious or deep sedation: a questionnaire regarding the experience of parents,children and staff during small bowel biopsy

Aim: The paediatric clinics of Linköping and Norrköping, Sweden, have different procedures regarding premedication and sedation during small bowel biopsy in children with suspected or diagnosed coeliac disease. In Linköping deep sedation using intravenous propofol is the method of sedation being used and parents are not present during the biopsy procedure. In Norrköping conscious sedation using intravenous midazolam is the routine and parents stay with their child throughout the whole biopsy procedure. The aim of this study was to find out whether the preprocedural and procedural differences between the clinics affected the way in which the parents and children experienced the time before and during the biopsy procedure. Methods: A questionnaire was used to ask the parents of 102 children who had undergone small bowel capsule biopsy for their opinion regarding the discomfort experienced by their children. The parents’and children's experience was also compared with that of the paediatric nurse caring for the family during the biopsy procedure, and the paediatric gastroenterologist performing the biopsy. Results: The differences regarding premedication and sedation between the two groups did not seem to affect the parents’or the children's total experience of the biopsy procedure, nor did the presence or absence of the parents throughout the biopsy procedure. As regards the sedation given, 95% of the parents did not think that their children suffered any discomfort at all. The total experience of the biopsy procedure on a five‐grade scale (5 being very good, 1 being very bad) was 5 for the parents and 4 for the children in both centres. Parents and children in both centres were very satisfied with the way in which they were taken care of during their visit to the hospital. In both units there was an obvious correlation between how the paediatric nurse experienced the biopsy procedure and how the paediatric gastroenterologist did, but only a weak correlation between the experience of the parents and that of the paediatric gastroenterologist and paediatric nurse. The anxiety of the parents was similarly estimated by the paediatric gastroenterologist and the paediatric nurse in both centres. There was no correlation between their assessment and the experience reported by the parents. Conclusion: The children undergoing small bowel biopsy and their parents felt well taken care of during their visit to the two hospitals. The differences between the clinics regarding method of sedation and presence or absence of the parents did not seem to affect how the parents and children experienced the biopsy procedure.     

Chloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial

OBJECTIVE: The comparative safety and efficacy of chloral hydrate and midazolam for sedation of children has not been adequately studied. METHODS: In a double-blind randomized trial, at a single university hospital, we enrolled 40 children, ages 2 months to 8 years, in an out-patient neuroimaging study. Children judged to require sedation were enrolled during a 14-month period ending August 1995. They received identically appearing liquids of equal volume of either chloral hydrate (75 mg/kg, maximum 2 g) or midazolam (0.5 mg/kg, maximum 10 mg) by mouth. Children were monitored for changes in arterial blood pressure, oxygen saturation, pulse, respiration and anxiety. Efficacy was judged by evaluating the child's ability to complete the intended scan. Supplemental dosing was administered to children who were judged inadequately sedated 30 minutes after the initial medication. RESULTS: Interim analysis demonstrated a significant sedation failure rate. Of 40 enrolled children, 33 completed the protocol. Efficacy was significantly improved for the chloral hydrate group for both ability to perform the scan, chloral hydrate = 11/11 (100%, 95% CI = 72-100) vs. midazolam = 11/22 (50%, 95% CI = 29-71), and the need for supplementary dosing, chloral hydrate = 1/11 (9%, 95% CI = 0-26) vs midazolam = 12/22 (55%, 95% CI = 34-76), P<0.05. Mean duration of sedation was not significantly different. No physiological deterioration occurred and no oxygen administration was required. CONCLUSIONS: We conclude that, in these doses, oral chloral hydrate may provide more effective sedation than midazolam for brief neuroimaging studies in young children.     

Hospital Costs,Revenue, and Abuse Detection Associated With Occult Injury Screening

ObjectivePerformance of occult injury screening including skeletal surveys and neuroimaging is recommended to comprehensively evaluate suspected child physical abuse. Screening performance-associated hospital costs and net revenue for care of index abuse victims and siblings/household contacts are largely unknown. We aimed to describe 1) costs and net revenue associated with radiologic occult injury screening at an urban level 1 pediatric trauma center, 2) areas of perceived high resource intensity (time spent in abuse victim-related care), and 3) detection yield among children undergoing occult injury screening and physical assessment.MethodsUsing time-driven activity-based cost analysis, hospital, per physician, staff, and radiology costs associated with occult injury screening performance were mapped for 199 children <2 years old. Hospital costs and resource times were approximated and compared with net revenue for each healthcare encounter. Abstracted variables included index/sibling status, injury classification, and length of stay (LOS).ResultsOf 199 children with variable LOS (0–45 days), total hospital costs (facility, physician, staff, radiology) ranged $297.83 to $81,474; net revenue was positive. Total ED time per abuse case varied 32 to 1823 minutes; social work (SW) time ranged 44 to 720 minutes; prolonged ED/SW time represented resource-intense areas. Of siblings, 27% were diagnosed with unanticipated findings based on occult injury screening and examination.ConclusionsAt a single center, occult injury screening was associated with cost variability, resource intensity, and enhanced victim identification when external examination findings or clinical symptoms were absent. While further study is needed, cost and resource concerns associated with screening may be offset by societal benefit and minimal hospital-based financial losses.     

Oral chloral hydrate vs. intranasal midazolam for sedation during computerized tomography

We conducted this single blind randomized clinical trial to compare the efficacy and safety of oral chloral hydrate and intranasal midazolam for induction of sedation for computerized tomography scan of brain in children. Participants aged 1–10 years (n=60) were randomized to receive 100 mg/kg chloral hydrate orally with intra nasal normal saline OR intranasal midazolam 0.2 mg/kg with oral normal saline. Adequate sedation (Ramsay sedation score of four) was obtained and CT scan completed successfully in 76.7% of chloral hydrate group and in 40% of midazolam group (P=0.004). No significant difference was seen for side effects frequency between the two drugs (10% in chloral hydrate, 3.3% in midazolam group; P= 0.34). We conclude that oral chloral hydrate can be considered as a safe and effective drug for sedation in children undergoing CT scan of brain.     

Ketamine and midazolam for invasive procedures in children with malignancy: a comparison of routes of intravenous, oral, and rectal administration

We investigated the efficacy of a combination of ketamine and midazolam, comparing intravenous, oral, and rectal administrations for invasive procedures in children with malignancy. Seventy-three children under 5 years of age, who were scheduled for invasive procedure, were assigned to one of three groups: IV group (n = 25), ketamine 1 mg/kg and midazolam 0.05-0.1 mg/kg were given intravenously; PO group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg were given orally; and PR group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg given rectally. Vital signs including blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored, and patients were observed for side-effects. Optimal sedation (drowsy and asleep) was provided in 78 per cent of all patients and no statistical difference was observed among the three groups. No severe complications were observed in all groups. Recovery time from sedation was significantly longer in the intravenous group (>120 min in two patients). Hallucination was noted in three (12 per cent) patients given intravenous medication, but not in those given oral or rectal medications. It is concluded that intravenous, oral, and rectal midazolam/ketamine are equally effective for invasive procedures in children with malignancy. The use of intravenous ketamine/midazolam may produce prolonged sedation and psychedelic effects in children. These adverse effects may alter the child's comfort and parental satisfaction.     

The Impact of Universal Mental Health Screening on Pediatric Emergency Department Flow

Objective and HypothesisAssess the impact of universal mental health screening with MyHEARTSMAP on emergency department (ED) flow, an important aspect of feasibility. We hypothesized that the difference in departmental level ED length of stay (LOS) for screening and matched nonscreening days is less than 30 minutes.MethodsWe conducted a 2-center, retrospective cohort study between December 2017 and June 2019. At each center, random mental health screening days were assigned over the course of 15 consecutive months. We matched each 24-hour screening day to a unique nonscreening day based on: location (Center 1 or Center 2); day type (weekday: Monday-Thursday or weekend: Friday-Sunday); date (±28 days); and 24-hour volume (±15 patients). We collected retrospective patient flow data, including LOS, across all ED visits to determine the difference in departmental level median LOS between matched screening and nonscreening days.ResultsThere was not a statistically significant difference in departmental LOS between screening and nonscreening days. Overall, the difference in departmental LOS was ?4.0 minutes (95% confidence interval, ?9.8, 1.8) for screening days compared to nonscreening days, with a difference of ?2.0 minutes (?9.0, 4.9) at Center 1 and ?6.0 minutes (?15.4, 3.4) at Center 2.ConclusionsOur findings show that universal mental health screening with MyHEARTSMAP can be implemented without a significant impact of ED LOS.     

Evaluation of intranasal midazolam in refraction and fundus examination of young children with strabismus

PURPOSE: To determine the clinical sedative effect and dosage of intranasal midazolam in refraction and fundus examination of children with strabismus. PATIENTS AND METHODS: Refraction and fundus examination with (n = 28) and without (n = 24) sedation were performed in 52 children with strabismus whose ages ranged from 7 to 26 months. We delivered a 5-mg/mL solution of midazolam via a syringe for 60 seconds to provide a dose of 0.2 mg/kg. We repeated the dose to a maximum of 0.3 mg/kg if there was no clinical sedative response after 10 to 15 minutes. The ease of examination and sedation for each patient was scored by a blinded observer. The groups were evaluated for ease of examination and the time needed to complete it. RESULTS: We obtained clinically adequate sedation at a mean (+/- standard deviation) of 15 minutes (+/- 2.69 minutes). Sedation was achieved with a mean dose of 2.64 mg/kg (+/- 0.66 mg/kg). Children receiving midazolam had significantly calmer examination scores. The time needed to complete the examination was statistically significantly shorter for these children than for children not receiving sedation (P < .05). CONCLUSIONS: Intranasal midazolam is a beneficial drug and method of delivery for the sedation of anxious children with strabismus undergoing refraction and fundus examination. Sedation prior to examination is effective in reducing the anxiety and time associated with ophthalmologic examination of children with strabismus.     

Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

BACKGROUND: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. OBJECTIVE: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. MATERIALS AND METHODS: The study was prospective, randomised and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. RESULTS: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group ( P<0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo ( NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. CONCLUSIONS: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination.     

A randomized, blinded comparison of chloral hydrate and midazolam sedation in children undergoing echocardiography

The objective of this prospective, randomized, and blinded study was to compare the use of chloral hydrate versus oral midazolam sedation in children undergoing echocardiography. No adverse effects (nausea, vomiting, paradoxical agitation, or significant deviations from baseline vital signs) were noted with either medication. No differences were noted in onset of sedation between the 2 groups, however, the time to complete recovery was significantly shorter with midazolam than with chloral hydrate. The children in the chloral hydrate group had a significantly deeper level of sedation and were more likely to receive a more nearly comprehensive echocardiographic evalation.