- A study focusing on side effects of chloral hydrate showed a higher
dose led to a higher incidence of paradoxical excitement. In addition,
the excitement was more commonly seen in older children.2
- Even though no significant adverse effects were observed in these
studies, one still needs to consider that other oral sedatives do exist
and comparison studies to these agents would be very useful in determining
the use of chloral hydrate.
- A study comparing propofol and chloral hydrate found that there was
a 19% incidence of chloral hydrate causing excitement and 3% incidence
of respiratory depression; the incidence of both of these adverse
events for propofol were 0%.3 However, propofol is
not as viable an alternative for use with outpatient echocardiography.
- The AAP guidelines do make mention of the concern of carcinogenesis
of chloral hydrate. There are no studies in humans. The
studies in mice that showed an increased risk of hepatic tumors was
in mice who received daily chloral hydrate for 2 years. Some benzodiazepine
and barbiturate sedatives have been shown to be carcinogenic in animal
studies as well.4
- The AAP policy statement also raises concern that repetitive dosing
of chloral hydrate is concerning due to the accumulation of metabolites
which may produce excessive central nervous system depression, predispose
newborns to conjugated and nonconjugated hyperbilirubinemia, decreased
albumin binding of bilirubin and contribute to acidosis.
Napoli KL, Ingall CG, Martin GR. Safety and ffficacy of chloral
hydrate sedation in children undergoing echocardiography. Journal
of Pediatrics 1996:129(2):287-291.
Lipshitz M, Marino BL, Sanders ST. Chloral hydrate side effects
in young children: Causes and management. Heart and Lung
Merola C, Albarracin C, Lebowitz P, Bienkowski RS, Barst SM. An
audit of adverse events in children sedated with chloral hydrate or
propofol during imaging studies. Paediatric Anaesthesia
1995: 5(6): 375-378.
American Academy of Pediatrics. Use of chloral hydrate for sedation
in children. Pediatrics 1993: 92(3): 471-473.