BACKGROUND Although chloral hydrate has been used as a sedative for more than 100 years, dozens of studies have reported that it has inconsistent sedative effects and high sedation failure rates with initial dose. The high failure rates may lead to repeated administration of sedatives, guardians' dissatisfaction, parental anxiety, increasing medical workload as well as leading to an increase of adverse events. Our aim is to identify the risk factors associated with chloral hydrate sedative failure with initial dose in children undergoing noninvasive diagnostic procedures. METHODS Pediatric patients who underwent chloral hydrate sedation for noninvasive diagnostic procedures at our institution between 1 December 2019 and 1 January 2021 were retrospectively analyzed. Data collected included patients' age, gender, weight, sedation history, sedation failure history, type of procedures, initial dose of choral hydrate, sleep deprivation, sedation failure with initial dose, and sedative duration. The initial dose was classified into three levels: reduced dose (< 40 mg/kg), standard dose (40-60 mg/kg), and high dose (> 60 mg/kg). The patients were divided into three cohorts according to the different initial doses. RESULTS A total of 15,922 patients were included in the analysis; 1928 (12.1%) were not well-sedated after administering the initial dose of chloral hydrate. The highest sedative failure was observed in the reduced dose group. By multivariate regression, we identified that heavier weight, patients with a history of sedation or a history of sedation failure, and patients who received magnetic resonance imaging (MRI) or more than one procedure simultaneously were associated with an increased odds of sedation failure at the initial dose. However, outpatients, patients undergoing hearing screening, and patients with sleep deprivation were favored regarding chloral hydrate sedative success. CONCLUSION An alternative drug or drug combination is necessary in patients with heavier weight, those with a sedation history or sedation failure history, and those undergoing an MRI or more than one procedure simultaneously, whereas chloral hydrate is an appropriate sedation option for outpatients, patients undergoing hearing screening, and those with sleep deprivation.

中文翻译：

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小儿患者初始剂量水合氯醛镇静失败的危险因素分析：回顾性分析。

背景尽管水合氯醛作为镇静剂已被使用了 100 多年，但数十项研究报告称其镇静效果不一致，初始剂量镇静失败率高。高失败率可能导致重复使用镇静剂、监护人的不满、父母的焦虑、增加医疗工作量以及导致不良事件的增加。我们的目的是确定与接受无创诊断程序的儿童初始剂量水合氯醛镇静失败相关的风险因素。方法 回顾性分析 2019 年 12 月 1 日至 2021 年 1 月 1 日期间在我院接受水合氯醛镇静以进行无创诊断程序的儿科患者。收集的数据包括患者的年龄、性别、体重、镇静史、镇静失败历史、程序类型、水合合唱的初始剂量、睡眠剥夺、初始剂量的镇静失败和镇静持续时间。初始剂量分为三个级别：减少剂量（< 40 mg/kg）、标准剂量（40-60 mg/kg）和高剂量（> 60 mg/kg）。根据不同的初始剂量将患者分为三组。结果 共有 15,922 名患者被纳入分析；1928 (12.1%) 在给予初始剂量的水合氯醛后没有得到很好的镇静。在减少剂量组中观察到最高的镇静失败。通过多元回归，我们发现体重较重、有镇静病史或镇静失败史的患者，并且同时接受磁共振成像 (MRI) 或多个手术的患者与初始剂量镇静失败的几率增加有关。然而，门诊患者、接受听力筛查的患者和睡眠不足的患者在水合氯醛镇静成功方面受到青睐。结听力筛查和睡眠不足的人。睡眠剥夺的患者在水合氯醛镇静成功方面受到青睐。结听力筛查和睡眠不足的人。睡眠剥夺的患者在水合氯醛镇静成功方面受到青睐。结听力筛查和睡眠不足的人。