I concur with your reservations w.r.t Chloral Hydrate for "brief" sedation in the ED. It's long half life (4-6 hours), as Rick (Place, MD) alluded to, and the inability to titrate, makes it an inferior choice, as compared to alternatives like propofol, methohexital, pentobarbital or midazolam, for sedation during cranial imaging.
Ventricular dysrhythmias are a well known side effect of halogenated hydrocarbons, like CH.The combination of ventricular arrhythmias and coma without hypoxia is typical of CH overdose. It has been described with as little as 1.5 gm in children. Do you recall how much your patient had received?
Most of the significant sedation related adverse events in the literature have been with the use of CH. The common theme was failure to recognize that in doses ranging from 50-100 mg/kg it is a sedative hypnotic, with potential for respiratory depression. They were not monitored closely especially in the vulnerable post procedure period.
I had an opportunity to review this for our poison control newsletter during my fellowship. For a quick overview on the pros and cons of CH use and the management of an overdose, the following article might be of assistance to you...
Pershad J, Nichols M, Palmisano " Chloral Hydrate - The good and the bad" Pediatr Emerg Care 1999; 15(6): 1-4.
Good luck ...
LeBonheur Children's Medical Center
----- Original Message -----
> Personally, I like to use propofol in short procedures and for CT
> scans. I have had very good results with it. In my residency, we had
> a pt that we used chloral hydrate for sedation. There was a mix up in
> the administration of the drug and the pt ended up getting about 1
> 1/2 the normal dose. Anyway, the pt developed ventricular arrhythmias
> and ended up in the PICU for a week. We did a literature search and
> found that this was not uncommon. Since then, I'm rather hesitant to
> use it. I am still in training though and am always interested in
> other options and opinions.
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