Description

Midazolam is a benzodiazepine that falls under the anxiolytic drug category as it makes children more manageable. It increases Gamma-Amino Butyric Acid (GABA) in the brain and is frequently used for sedation in the pediatric population because it is short acting and has quick onset properties. By increasing GABA in the brain, it enhances chloride flux resulting in membrane hyperpolarization and inhibition of action potential, and thus decreased cell activity. The desired clinical effects are muscle relaxation, ante grade amnesia, sedation, and in high doses hypnosis. The adverse effects it can cause are respiratory depression, a mild decrease in cardiac output, and decreased oxygen consumption by the brain, but rarely occur when given alone and normally happen when given in conjunction with other sedatives . Paradoxical reactions such as inconsolable crying and aggressive behavior although rare can occur, and should be reversed with Flumazenil, a GABA receptor antagonist. It is frequently used in conjunction with other sedatives to achieve optimal results, as it is not always reliable when given alone in procedures requiring more immobilization. Its ability to be administered orally, via IV, rectally, and intranasal is also beneficial. Nonetheless, midazolam has variable metabolism when administered orally making dosing difficult.

Chloral Hydrate

Chloral hydrate is a hypnotic drug that is most widely used in sedation of pediatric patients here in India, and generally considered safe and effective. It is a 2,2,2-trichloroacetaldehyde, that is metabolized in the liver by alcohol dehydrogenase into trichloroethanol, the active metabolite. It is highly effective in non-painful procedures like TTEs, CTs, and MRIs which demand complete immobilization. It can be administered either oral or rectal and dosed at 50-75 mg/kg. It has an induction time of 15-25 minutes, and a recovery time of 60-120 minutes. For these reasons it is no longer recommended in many parts of the world [11]. Some of the common adverse effects include oxygen desaturation, cardiac arrhythmias, vomiting, and agitation.

With Best Regards,
Tony Wilson
Journal Coordinator
Insights in Pediatric Cardiology