Comparative Effectiveness of Intranasal Dexmedetomidine–Midazolam versus Oral Chloral Hydrate Targeting Moderate Sedation during Pediatric Transthoracic Echocardiograms

Abstract

<b>Objective</b> To compare efficacy and safety of two moderate sedation regimens for transthoracic echocardiography (TTE): intranasal dexmedetomidine-midazolam (DM) versus oral chloral hydrate (CH) syrup. <b>Method</b> This was a retrospective cohort of 93 children under 4 years of age receiving moderate sedation with either DM or CH for TTE from January 2011 through December 2014. <b>Measurements and Main Results</b> Forty-nine patients received oral CH and 44 received the intranasal combination of DM. The demographics between groups were similar except the DM patients were slightly older and heavier (each <i>p</i> < 0.05). Failure rate between groups did not reach statistical significance (CH 14.3% vs. DM 6.8%; <i>p</i> = 0.324). Total sedation to discharge time was similar between groups (CH 89.4 minutes vs. DM 89.6 minute; <i>p</i> = 0.97). Cardiopulmonary data did reveal a significantly lower heart rate (101.9 vs. 91.7; <i>p</i> < 0.001) and respiratory rate (23.4 vs. 21.0, <i>p</i> = 0.03) in the DM group, but no difference in blood pressure measurements or echo determined shortening fraction. <b>Conclusion</b> These data support the use of intranasal DM as a safe and efficacious method of moderate sedation for children undergoing TTE.