Pediatric Sedation Guidelines

Introduction to Sedation

• The recommended dose of chloral hydrate for pediatric sedation is 50-75 mg/kg orally, with additional doses of 25-50 mg/kg up to a maximum of 100 mg/kg as needed, according to the American Academy of Pediatrics 1

Dosing and Administration

• The maximum total dose of chloral hydrate should not exceed 100 mg/kg (not to exceed 1,000 mg) 1
• Administer chloral hydrate 30-60 minutes before the procedure 2

Monitoring and Augmentation

• Continuous pulse oximetry, regular vital sign assessment, and dedicated individual monitoring throughout the procedure are required 2
• If sedation is inadequate after 30 minutes, additional doses of 25-50 mg/kg may be given, with a total dose not exceeding 100 mg/kg 1

Alternative Sedatives

• Oral pentobarbital may be used as an alternative, with a dose of 4-8 mg/kg, similar efficacy profile to chloral hydrate 3
• IV pentobarbital may be used if IV access is already established, with a dose of 2-6 mg/kg 3
• Ketamine may be used for more invasive procedures requiring deeper sedation, with a dose of 0.25-0.5 mg/kg IV 3

Safety and Monitoring

• Fatal respiratory depression has been reported in children younger than 2 years, prompting a black box warning 2
• Monitoring should continue until discharge criteria are met, as re-sedation can occur after apparent recovery, particularly in infants and toddlers transported in car safety seats 2
• The liquid formulation of chloral hydrate is no longer commercially available from manufacturers but may be compounded by hospital pharmacies 2

Time to Sedation and Duration of Action

• The time to sedation with chloral hydrate is 16 ± 11 minutes on average 3