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S. Arango; Efficacy and Safety of Chloral Hydrate in Sequential, Short Term Monitoring of IOP in Pediatric Glaucoma . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4360.
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Purpose:The use of Chloral Hydrate has been controversial since several adverse events have been reported. It's optimal dose has not been established. There are no data of safety and efficacy in sequential sedation in monitoring IOP in pediatric glaucoma. It's one of the preferred methods of evaluating IOP but it's use has been restricted in many hospitals. According to previous studies there is no change in IOP in comparison to some inhaled anesthetics and makes it a more reliable method of IOP follow up in this population. The goal was to evaluate the safety and efficacy of chloral hydrate in a short term period, establish an ideal dose for sedation, find out the importance of side effects and motivate ophthalmologist to increase it's current use Methods: During a multicenter, double blind study, comparing the safety of Dorzolamide and Timolol in pediatric glaucoma between April 2001 and November 2002, 18 patients, ages between 3 months and 5 years (average 2 years) were sedated to monitor IOP at day 1 before starting the study drug, some of them at week 1, week 4 and week 12. Perkins tonometer was used in all cases. The sedation was supervised by an anesthesiologist and the patients were monitored at the pediatric recovery room. 75 mg/kg were given oral in a 10cc syringe and an extra dose up to 100mg/ kg if sedation wasn't achieved in 25 minutes. Adverse effects were evaluated during and after sedation Results:15 patients required 75 mg/ kg and 3 needed a dose 100 mg/kg. A total of 61 sedations were done. An average of 3 sedations per patient were done in a 3 month study period. No serious side effects were present during or after sedation. Irritability was present in 5 procedures and vomiting in 1. In the post sedation phase 13 kids presented somnolence as the most common side effects. Others such as irritability, diarrhea, vomiting and walking instability were just occasional among them,1 episode each. Average time between the given dose and full sedation was 17(5-30) minutes and recovery 90 minutes (30-150). No intervention by the anesthesiologist was required. No changes in heart or respiratory rate were found nor differences in results between ages and sexes. Conclusions: The ideal dose for sedation seems to be 75 mg/kg. Mild side effects were present and no serious side effects were found . Chloral hydrate use is safe and efficacious in sequential, short term, IOP monitoring in pediatric glaucoma and it can be used as a standard procedure in the IOP follow up of these patients.
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