Comparison Of Chloral Hydrate Solution, Hydroxyzine Syrup And Lidocaine/Prilocaine Cream As Premedication For Lumbar Puncture In Children, A Double Blind Study

  ObjectivesThis study aimed to compare the clinical effectiveness of oral hydroxyzine and chloral hydrate to topical lidocaine/prilocaine 2.5% cream as premedication in pediatric leukemia patients. Material & Methods This double-blind clinical trial study was conducted on 70 leukemic and non-leukemic patients aged 3-11 years old. The patients were divided into 4 groups as follow: in the group A, choral hydrate solution was given in 18 patients, in group B hydroxyzine syrup was used in the same number of patients, in group C, chloral hydrate solution and Lidocaine/Prilocaine cream were used in 17 patients, and in group D hydroxyzine syrup and Lidocaine/Prilocaine cream were given in the same number of patients. These groups were assessed and judged based on visual analog scale (VAS). Side effects of the drugs were also recorded. Results In this study, 54.3% (38) of cases were girls and 45.7% (32) were boys. Patients’ selection was included as follow: ALL in 77%, AML in 7.2% and non-leukemic cases in 15.8% of cases. The VAS test showed no difference in these four groups. Non-Traumatic lumbar puncture (RBC<50) were seen in 97.1% of cases. Conclusion Although the use of pre-medications for lumbar puncture with hydroxyzine syrup and chloral hydrate solution was not statistically effective, it did lead to increased patient and parent satisfaction. Also, adding  the Lidocaine/Prilocane cream does not improve the effectiveness of the drugs. &nbsp

Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate

How to Cite This Article: AshrafiMR, Azizi Malamiri R, Zamani GR, Mohammadi M, Hosseini F. Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate. Iran J Child Neurol. 2013 Winter;7(1):15-19.ObjectiveElectroencephalography (EEG) recording is a long duration procedure that needs patient’s cooperation for device setup and performing the procedure. Many children lose their cooperation during this procedure. Therefore, sedation and sleep are frequently induced using a few agents as pre procedure medication in children before EEG recording. We aimed to compare the sedative effects of oral midazolam versus chloral hydrate before the procedure along with their impacts on EEG recording in children.Materials & MethodsA randomized trial was carried out to compare the sedative effects of oral midazolam versus chloral hydrate and their impacts on EEG recording in children. A total of 198 children (100 in the midazolam group and 98 in the chloral hydrate group) were enrolled in the study and randomly allocated to receive either oral moidazolam or chloral hydrate.ResultsOral midazolam had superiority neither in sleep onset latency nor in sleep duration when compared to chloral hydrate. Moreover, the yield of epileptiform discharges in the chloral hydrate group was more than the midazolam group.ConclusionThe results of this study showed that both chloral hydrate 5% (one ml/kg) and oral midazolam (0.5 mg/kg) could be administered as a pre medication agent for EEG recording in children. However, oral midazolam at this dose had no advantage compared with chloral hydrate.ReferencesAshrafi MR, Mohammadi M, Tafarroji J, Shabanian R, Salamati P, Zamani GR. Melatonin versus chloral hydrate for recording sleep EEG. Eur J Paediatr Neurol 2010;14(3):235-8.Slifer KJ, Avis KT, Frutchey RA. Behavioral intervention to increase compliance with electroencephalographic procedures in children with developmental disabilities. Epilepsy Behav 2008;13 (1):189-95.Gauillard J, Cheref S, Vacherontrystram MN, Martin JC. [Chloral hydrate: a hypnotic best forgotten?]. Encephale 2002;28(3 Pt 1):200-4.Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000;106(4):633-44.Greenblatt DJ, Ehrenberg BL, Culm KE, Scavone JM, Corbett KE, Friedman HL, et al. Kinetics and EEG effects of midazolam during and after 1-minute, 1-hour, and 3-hour intravenous infusions. J Clin Pharmacol 2004;44(6):605-11.Gurakan F, Yuce A, Ozen H, Saltic IN. Midazolam and pethidine for the sedation of children undergoing gastrointestinal endoscopy. Crit care med 2000;28(6):2176-7.Karl HW, Cote CJ, McCubbin MM, Kelley M, Liebelt E, Kaufman S, et al. Intravenous midazolam for sedation of children undergoing procedures: an analysis of age- and procedure-related factors. Pediatr Emerg Care 1999;15(3):167-72.Lightdale JR, Mitchell PD, Fredette ME, Mahoney LB, Zgleszewski SE, Scharff L, et al. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy. Int J Pediatr 2011; 2011:623710.Massanari M, Novitsky J, Reinstein LJ. Paradoxical reactions in children associated with midazolam use during endoscopy. 1997;36(12):681-4.Scott RC, Besag FM, Boyd SG, Berry D, Neville BG. Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics. Epilepsia 1998;39(3):290-4.Loewy J, Hallan C, Friedman E, Martinez C. Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy. Am J electroneurodiagnostic technol 2006;46(4):343-55.Rodriguez E, Jordan R. Contemporary trends in pediatric sedation and analgesia. Emerg Med Clin North Am 2002;20(1):199-222.Sisson DF, Siegel J. Chloral hydrate anesthesia: EEG power spectrum analysis and effects on VEPs in the rat. Neurotoxicol Teratol 1989;11(1):51-6.Thoresen M, Henriksen O, Wannag E, Laegreid L. Does a sedative dose of chloral hydrate modify the EEG of children with epilepsy? Electroencephalogr Clin Neurophysiol 1997;102(2):152-7

Clonidine Versus Chloral Hydrate for Recording Sleep EEG in Children

ObjectiveOne of the difficulties for conduct electroencephalography (EEG) in pediatric patient population is that they are not always cooperative during the procedure. Different medications have been used to induce sedation during EEG recording. In order to find a medication with least adverse effects and high efficacy, we aimed to compare clonidine and chloral hydrate as a premedication prior EEG performing in pediatric population. Materials & MethodsA prospective, randomized, single-blinded, controlled trial was carried out over 198 children (9 to 156 months) to investigate the sedative and adverse effects of clonidine and chloral hydrate. Patients, partially sleep-deprived the night before, were randomly divided in two groups of clonidine (100 patients) and chloral hydrate (98 patients), on an alternative day basis.Results The average sleep onset latency was significantly longer in the clonidine group than chloral hydrate group (Mann-Whitney test, p < 0.0001). Sleep duration ranged between 15-150 minutes and it was not significantly different between two groups (Mann-Whitney test p = 0.2). Drowsiness with chloral hydrate terminated faster than with clonidine. Drowsiness after arousal was seen in 58% and 26.1% of patients in the clonidine and chloral hydrate groups respectively that was  significant  (Mann-Whitney test, p = 0.058). EEG results were reported normal in 77 subjects in the chloral hydrate group (77%) and in 69 subjects (69%) in the clonidine group (p = 0.161). Generalized epileptiform discharges  reported significantly  in the clonidine group  (Mann-Whitney test , p = 0.006).ConclusionThe results of this study showed that both chloral hydrate 5% (one ml/kg)and clonidine (4 μg/kg)could be administered as a pre medication agent for EEG recording in children , although drowsiness after arousal of clonidine is greater than chloral hydrate . However, the yield of generalized epileptiform discharges in the clonidine group was more than the chloral hydrate group.

Acute Cerebellitis Following Opium Intoxication: A Case Report and Literature Review

Introduction: Acute cerebellitis (AC) is a rare potentially life-threatening condition in children. Some viral infections, vaccines and neuroimmunologic disorders are the most common causes of AC. Opium poisoning is an unusual cause of this condition. Case presentation: A 2-year-old girl was referred with loss of consciousness. She was ataxic just a few minutes after opium ingestion and after 1 hour, she became unconscious. We only found pinpoint pupils. After naloxone drip, her condition had been better but she was still obtunded and her urine was positive for opium products (morphine). MRI of the brain showed marked bilateral cerebellar swelling that respond to high-dose steroid dramatically. Conclusion: This case shows that opium intoxication should be considered as a rare cause of acute cerebellitis in children

Be Careful of Lies: a 6 Years Old Boy with Respiratory Distress and Decreased Level of Consciousness

We reports a six-year-old child with autistic disorder and methadone intoxication. Developmental disorders may mislead the caretakers and doctors to interpret the clinical manifestation and behavioral changes of these patients. Methadone indigestion can be fatal in children even in a tiny amount and cardiac monitoring should be performed at least for the first 24 hours. The pervasive prescription of methadone for detoxification programs and its extensive availability at homes of the addicted parents should point parents, doctors and media to pay more attention to provide safe-home environment for children

Pseudotumor Cerebri in a Case of Ulcerative Colitis with Sagittal Sinus Thrombosis

Background: Thromboembolic events are a known complication of Inflammatory Bowel Disease (IBD) especially during disease relapse, more commonly in deep veins of extremities and lung, and rarely as Cerebral Sinovenous Thrombosis (CSVT). Case Presentation: We describe an 11 year, old male patient with 3 months history of Ulcerative Colitis (UC) who presented as pseudotumor cerebri due to superior sagittal sinus thrombosis during an acute exacerbation of his colitis, that was successfully treated with heparin and then warfarin. Conclusion:In any known cases of UC presenting as acute severe headache, consider CSVT and request brain MRI and MRV to facilitate the diagnosis and early treatment

Sudden Impolite Behavior in a Polite Girl: a Case Report

In this case we present a previously healthy child with sudden behavioral change and acute confusional state (ACS). ACS is a neurologic emergency. The clinical manifestations of ACS are; confused affect, limited verbal response, disturbance in performing orders, some automatism, stable vital signs and absence of tonic-clonic movements and it has a wide range of differential diagnosis which should be assessed by detailed medical history, medical examination and laboratory tests. The only abnormal test found in this patient, was cerebrospinal fluid abnormality, consistent with viral encephalitis

Evaluation of Neurological and Auditory Development in Children with Congenital Heart Disease using Essence Q Questionnaire and Auditory Brainstem Response (ABR) Test: neurological ,auditory development in congenital heart disease

ObjectivesThe progress of cardiac surgery in children and the increase in the survival of children with Congenital Heart Disease (CHD) has led to consider another issue called a neurodevelopmental disorder. In this study, 53 children with CHD were evaluated in terms of development with the Essence Q questionnaire, Otoacoustic Emission (OAE), and Auditory Brainstem Response (ABR) regarding these patients’ hearing and risk factors. The Essence Q scores were also examined Materials & MethodsIn this prospective, cross-sectional study, the researchers included 53 children diagnosed with CHD. Initially, each child underwent ABR and OAE tests. Subsequently, data on potential risk factorsassociated with neurodevelopmental delay were collected. A trained project associate administered the Essence Q questionnaire, using parents’ information as a guide. Following data collection, this study proceeded with an in-depth analysis of the information.ResultsThirty-six boys (67.92%) and 17 girls (32.08%) with CHD were included in the study. The mean age of children was 2/23+_8.11. The mean Essence Q score for boys was 7.48+_2.57.Moreover, the average score for girls was 2.23 8.11. According to this questionnaire, 39 patients (73.58%) had hyperactivity disorder,46 patients (86.79%) had behavioral disorders, and ten patients (16.98%) had a motor delay. Unlike previous studies, all patients had normal OAE and ABR hearing. ConclusionThis study demonstrated that factors such as developmental delay in the first year, a known genetic disease, and a history of seizures significantly impacted the Essence Q score. However, elements like prematurity, the use of ventilation, abnormalities on the dorsum, and the number of days post surgery did not significantly affect the Essence Q score. Essence Q can be a reliable tool in screening for neurodevelopment in children with CHD