The following is the summary of “Comparison of cerebral oxygen desaturation events between children under general anesthesia and chloral hydrate sedation – a randomized controlled trial” published in the December 2022 issue of Pediatrics by Gude, et al.


The goal of pediatric general anesthesia (GA) and sedation is to keep vital signs within healthy limits. Therefore, a decline in rScO2 below pre-intervention levels is not acceptable. Desaturations in the resuscitated partial oxygen saturation (rScO2) were examined between children sedated with GA and chloral hydrate sedation (CHS). About  92  youngsters were randomly divided into 2 groups for this study: CHS (n=40) and GA (n=52), both of which involved extensive auditory testing. The data came from a sample of 81 kids, with ages ranging from 1 month to 36 months. When working in the GA group, researchers adhered to a standard of 10 N. (no fear, no pain, normovolemia, normotension, normocardia, normoxemia, normocapnia, normonatremia, normoglycemia, and normothermia). Using microscopic evaluations of the ear canal performed during the procedure, ENT physicians in this group performed modest procedures on 29 individuals.

All children in the CHS group who received moderate sedation were monitored and treated according to the guidelines. In addition, a double-barreled nasal oxygen cannula with etCO2 monitoring and oxygen delivery was given to each infant. An injection of chloral hydrate was given with the consent of the parent present. 1 benefit of using sedation on kids is that they don’t need IV access. The fasting guidelines were observed by both groups, and a seasoned anesthesiologist was on hand for the entire procedure. Any drop in cerebral oxygenation to below 50% or below 20% from baseline for  ≥1 min was considered an adverse event (AE). The incidence of AE among study participants was the major outcome measure. Drop in rScO2 below baseline (%drop rScO2) was measured and correlated with the following secondary variables: percent of inspired oxygen (FIO2), oxygen saturation (SPO2), end-tidal carbon dioxide (etCO2), systolic and mean blood pressure (BP), and heart rate (HR).

No significant differences in AE incidence were found across the groups. Secondary endpoint analysis demonstrated a stronger correlation between HR and FIO2 and %drop rScO2 than between BP and etCO2. Previous research have mainly examined the effect of BP and etCO2; however, this study reveals the substantial connection between HR and rScO2 in children aged more than 3 years. Reduced times of brain desaturation may follow from rapid heart rate adjustment.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03739-8