Sedation for non-invasive diagnostic procedures in pediatrics: The comparison between oral midazolam, ketamine and chloral hydrate

Pediatric sedation for diagnostic procedures is essential. The drug of choice and standard protocol in pediatric procedural sedation and analgesia (PSA) was not introduced till now. The aim of present study was to compare the efficacy of oral midazolam, ketamine and chloral hydrate in PSA.
In this double-blinded clinical trial, 60 children undergoing diagnostic CT scan or audiometry were randomly divided into three groups; midazolam (M, 0.5mg/kg), ketamine (K, 5mg/kg) and chloral hydrate (CH, 50mg/kg). Separation condition, sedation and anxiety score were recorded every 5 minutes and movement score were recorded in 0, 15, and 30 minutes after starting procedure and compared between groups.
the mean score of separation condition in CH group was significantly lower than others (p=0.000) and in K group lower than M group (p=0.001).the mean of separation time in M group (27.00±6.165) was significantly more than K group (20.26±5.13) and CH group (17.75±4.375) but there was no significant difference between K and CH groups. Sedation score in CH group was lower than others (p=0.000) and in K group lower than M group (p=0.000) with no difference between K and M groups (p=0.734). The mean of movement score in CH group was significantly lower than others (p=0.000) with no difference between K and M groups (p=1.00). There was no serious side effect or significant difference in mean of the sedation duration and hospital stay between three groups (p=0.659).
Oral Midazolam, Ketamine and Chloral hydrate are safe and effective for PSA and Midazolam anxiolysis effect was more than others which makes improvement in separation condition.