Chloral hydrate sedation has a negligible impact on intraocular pressure (IOP) in infants and young children

Abstract

Purpose : To determine the impact of chloral hydrate sedation on eye pressure in infants undergoing sedation for ophthalmic evaluation

Methods : Children aged 1 month to 5 years at King Khaled Eye Specialist Hospital undergoing examination under chloral hydrate induced sedation were enrolled in the study after written informed consent was obtained from their parents. Trained study personnel measured the IOP using an Icare tonometer prior to sedation (in some, not all children), at 25 minutes after sedation and then every 10 minutes until sedation was complete. Differences in means pre and first post sedation were compared using paired t-tests; IOP was monitored up to 2 hours post sedation, and its level was modeled using linear mixed models with time as the independent variable, allowing random effects for the intercept, the slope of time.

Results : A total of 115 children were enrolled, 50.4 % were female, and mean age was 2.1 (SD: 1.3) years from Jan 6^th 2014 through June 16^th 2016. Of the total, 86 (74.8%) participants had IOP measurement attempted prior to sedation, with 67 having pre-sedation IOP completed. Among those completing pre-sedation IOP, 48.8% were asleep or calm, and the rest (42.2%) were either slightly distressed or more distressed (IOP did not differ by level of agitation). Those with pre-sedation IOP available had similar demographics and health status (p > 0.05). Heart rate, respiratory rate and oxygen saturation all declined after sedation (p < 0.01). The mean dose of chloral hydrate administered was 81.1 (SD: 13.3) mg/kg, and sedation was deemed "adequate" in 96.3% after a single dose. Mean IOP among those with pre-sedation IOP was 19.7 (SD: 4.7) mmHg and this declined to 18.6 (SD: 4.8) mmHg at 25 minutes (p = 0.04). There was no trend towards further decline in IOP over time.

Conclusions : Chloral hydrate sedation is highly successful and low risk, and appears to alter IOP minimally in this prospective study of infants undergoing examination under anesthesia. Among those with pre-sedation IOP measurements, IOP decreased by an average of ≈1 mmHg. Those with higher IOP had similar stability of IOP under chloral hydrate sedation. Wider use of this form of anesthesia should be possible and effective in similar populations.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.