Chloral hydrate is a pure sedative/hypnotic with no analgesic properties that is used primarily for sedation of infants and young children requiring painless diagnostic procedures.12 The time to sedation is relatively long (45 to 60 min) and its effects can last several hours because of its active metabolite, making it an impractical agent for use in the ED. Adverse effects include nausea, vomiting, and paradoxical delirium/excitement, which are not reversible. Serious adverse effects including airway obstruction and death have been reported with chloral hydrate use.
The short-acting barbiturates can provide rapid onset of sedation for painless procedures such as computed tomography and magnetic resonance imaging studies in children with no preexisting central nervous system depression.13 Again, they have no analgesic or amnestic properties. Intravenous pentobarbital has an onset of action within 30 s and children are usually appropriately sedated within 5 min. Its duration of action is 30 to 60 min, making it a better choice for children undergoing emergent procedures. Respiratory and central nervous system depression can occur which can be exacerbated in the presence of other depressants such as opioids and benzodiazepines.
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