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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Surveys of PICU practice have shown that the most commonly used sedation regimes involve the administration of a sedative agent; usually a benzodiazepine such as midazolam, and an analgesic agent; usually an opiate such as morphine or fentanyl [3]. Enteral sedative agents, such as chloral hydrate, triclofos sodium and antihistamines are frequently introduced at an early stage and have been demonstrated to provide satisfactory levels of sedation. Dosing ranges and descriptions of commonly used agents are shown in Table 2.
Sedative/Hypnotics
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Frank A. Barile, Anirudh J. Chintalapati
Although it has no analgesic effect, and more effective and less toxic S/H drugs are available, chloral hydrate is still used therapeutically, primarily as a hypnotic.† Currently available in oral liquid dosage forms only, the compound is lipid soluble and is a metabolite of chloral betaine and triclofos (see structure in Figure 13.3). The long-acting metabolite of chloral hydrate, trichloroethanol, is responsible for most of its toxicity, low therapeutic index, and undetectable presence in plasma. Signs and symptoms of toxicity include CNS depression, ataxia, gastrointestinal irritation, cardiovascular instability, and proteinuria. In addition, chloral hydrate significantly impairs myocardial contractility by sensitizing the myocardium to catecholamines. An increased risk of sudden death with chloral hydrate intoxication is a result of the development of arrhythmias. Emergency guidelines and assessment of vital signs include pear-like breath odor, hypotension, and dysrhythmias. Gastrointestinal irritation and bleeding are also a common occurrence. Structure of chloral hydrate.
Use of tidal breathing curves for evaluating expiratory airway obstruction in infants
Published in Journal of Asthma, 2018
Avigdor Hevroni, Aliza Goldman, Miriam Blank-Brachfeld, Wiessam Abu Ahmad, Lior Ben-Dov, Chaim Springer
Measurements were performed according to ATS-ERS guidelines (2–4). Informed consent was given by the children's legal guardians prior to testing. Briefly, the infant was sedated using 100–150 mg/kg triclofos sodium syrup. Flows and volumes were measured using a heated pneumotachograph (series 3700A, Hans Rudolph Inc., USA) connected via a low-dead-space Rendell Baker face mask secured tightly in place with silicone putty. The pneumotachograph was connected to a differential pressure transducer and signal conditioner set to 100 Hz (SCIREQ TD-05 & SC-24). The combined effective dead space of the different mask sizes with the pneumotachograph was 19.5 ml for infants weighing over 9 kg, 17.5 ml for infants weighing between 6 and 9 kg, and 15 ml for infants weighing less than 6 kg (4).