An Observational Study of the Use of Chloral Hydrate for Ophthalmic Procedures in Children

Johns Hopkins University

Status: Completed

Conditions: Intraocular Pressure; Anesthesia

Treatments: Other: Intraocular pressure evaluation

Study type: Observational

Funder types: Other

Identifiers

NCT02985567

00086598

Details and patient eligibility

About

The study involves a prospective evaluation of chloral hydrate sedation for the measurement of intraocular pressure in children ages one month to five years of age.

Full description

This study will be a prospective, non-randomized trial of children 1 month to 5 years of age who are determined to require a sedation procedure at the King Khaled Eye Specialist Hospital (KKESH). There will be two parts to the consent process. Oral consent will be administered to subjects who are not undergoing eye pressure evaluation. These children have chloral hydrate sedation for imaging or other eye evaluations. For these children, we will prospectively monitor the success rate of chloral hydrate sedation such that a complete ophthalmic or imaging evaluation could be performed and will determine the proportion of adverse events that occur due to sedation including vomiting, respiratory distress or depression, alterations in vital signs beyond reference ranges for normal sleeping children, hypoxia with oxygen saturation <90%, and unplanned hospital admission. No testing will be performed for study purposes on these individuals.

For children undergoing sedation who will have intraocular pressure measurements for clinical care purposes, we will perform additional eye pressure measurements as part of the research protocol. Written consent will be obtained to allow us to additionally measure their intraocular pressure as specified below.

After recruitment and completion of informed consent procedures by parents, subjects' medical and ocular history will be reviewed by a study ophthalmologist and one of two pediatricians overseeing sedation procedures. Patients unable to undergo intraocular pressure measurement due to infection or ocular surface disease and those in whom chloral hydrate sedation is medically contraindicated will be excluded. Age, gender, diagnosis, current medications and surgical history will be recorded from the clinical chart for all subjects.

Enrollment: 324 patients

Sex: All

Ages: 1 month to 5 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ages 1 month to five years
• require sedation for ophthalmic care

Exclusion criteria

• weight <3 kg or >20 kg
• infection/ocular surface disease
• medical contraindication of chloral hydrate
• green or gray nasal discharge
• fever, productive cough, chest retractions, or other signs of respiratory infection
• oxygen saturation < 90%
• active infectious disease such as rubella or varicella
• rectal or tympanic temperature > 37.7 degrees, or oral or temporal artery temperature > 37.2 degrees
• history of current ongoing vomiting and diarrhea
• anemia (Hgb < 9.0mg),
• history of seizure in past 6 weeks

Trial design

324 participants in 2 patient groups

Intraocular pressure evaluation

Description:

Intraocular pressure evaluation using Icare tonometer 25 minutes after sedation, and then every 10 minutes until sedation is complete

Treatment:

Other: Intraocular pressure evaluation

Safety of sedation

Description:

Documentation of: 1. The need for repeat dosing of chloral hydrate. 2. The level of alertness of the patient at the end of sedation and the total time between induction and readiness for discharge 3. Interventions required for the patient including administration of oxygen, and need for intubation.