Avoid EUAs; Adequate Examination Possible Under Sedation with Chloral Hydrate

Abstract

Purpose: To find the safety and efficacy of oral sedation with Chloral Hydrate for ophthalmological examination of pediatric patients.

Material & Methods: In a prospective study from April 2010 till December 2011, 3500 children between the ages 4 months -6 years were examined under sedation with Chloral Hydrate Syrup given in a dosage not exceeding 25mg/kg body weight. There were 1900 males and 1600 females. Parents were informed to keep the neck of their child supported at all times while the child was in deep sleep. With the child fully sedated, retinoscopy, direct and indirect ophthalmoscopy, measurement of intraocular pressure was performed in all patients; B scan and axial length measurements were done in children with media opacity only.

Results: Adequate sedation was achieved in 98% children (3,430) within 30-40 minutes. In all children, retinoscopy, indirect ophthalmoscopy and measurement of intraocular pressurewas performed easily. B-scan, measuring axial length and calculation of IOL power was easily performed in children with pediatric cataract or media opacity. No side effects were noted in the 98% (3,430 cases). Side effects were noted in 2% (70 children); 62 (1.77%) children had vomiting with the first dose; out of these, 52 (1.48%) were sedated after a repeat dose mixed with juice at the same visit; 10 (0.28%) were called after one week and were given Chloral hydrate mixed with juice; no gastric irritation was noted at that visit. Eight children (0.22%), who were mentally subnormal, needed EUA.

Conclusion: Examination under sedation with Chloral hydrate syrup is safe and effective for complete ophthalmological examination and many un-necessary EUAs can be avoided. It saves not only the patient’s and clinician’s time but also reduces the workload in the operating theatres.