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Evaluation of Pediatric Procedural Sedation With Rectal Chloral Hydrate or Intranasal Midazolam

This study has been withdrawn prior to enrollment.
(Institution decided on starting a new protocol of sedation, with another methods and that´s why this study has not started.)
Information provided by:
University of Sao Paulo Identifier:
First received: July 19, 2011
Last updated: June 19, 2013
Last verified: July 2011

Thousands of children receive sedation for diagnostic and therapeutic interventions annually, and this number is expected to increase. Children are at higher risk for sedation-related complications than adults. In different scenarios, multiple drugs are used to achieve sedation, each one with particular adverse events that must be monitored and reported.

Children that need CT scans for traumatic brain injuries often need sedation, without needing and IV line for that. Chloral hydrate is an hypnotic agent used since 1832 with low incidence of adverse events; however, despite its worldwide use, it's being abandoned due to bitter taste, long time of sedation onset, vomiting and mild sedation. Intranasal midazolam, on the other hand, produces high and fast concentrations on CSF with greater rates of success but probably with higher adverse events. There are no prospective studies with large series of patients using intranasal midazolam.

The aim of this study is to determine if nasal midazolam is a safer approach and more effective sedative regimen when compared to rectal chloral hydrate to children undergoing CT scans.

Condition Intervention Phase
Traumatic Brain Injury
Computed Tomography
Procedural Sedation
Drug: Midazolam
Drug: Chloral Hydrate
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double Blind (Investigator, Outcomes Assessor)
Primary Purpose: Diagnostic
Official Title: Evaluation of Pediatric Procedural Sedation With Rectal Chloral Hydrate or Intranasal Midazolam - a Randomized Controlled Trial

Resource links provided by NLM:

Further study details as provided by University of Sao Paulo:

Primary Outcome Measures:
  • Adverse Events [ Time Frame: Participants will be followed for the duration of hospital (emergency department) stay, an expected average of 2-3 hours ]
    Such as hypoxemia, respiratory depression, vomiting, hypotension

Secondary Outcome Measures:
  • Efficacy of both drugs [ Time Frame: Participants will be followed for the duration of hospital (emergency department) stay, an expected average of 2-3 hours ]

    Patients vital signs and adverse events will be monitored through patient stay in the emergency department. Mean time after sedation is about three hours.

    Variables collected include Ramsay score for sedation. To consider hospital discharge, we will try to validate Aldrette score and compare the scores between the two arms. Mean time to onset of sedation and time of emergency department stay will also be compared as a mark of efficacy of these two drugs.

Enrollment: 0
Study Start Date: August 2011
Estimated Study Completion Date: August 2012
Estimated Primary Completion Date: August 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Chloral hydrate
Children undergoing CT scanning will receive in this arm 50 mg per kg of rectal chloral hydrate.
Drug: Chloral Hydrate
50 mg per kg, rectal
Active Comparator: Midazolam
Children undergoing CT scanning will receive in this arm 0,4 mg/kg of nasal midazolam.
Drug: Midazolam
0,4 mg per kg - intranasal midazolam - once


Ages Eligible for Study:   1 Month to 3 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • children undergoing CT scanning for TBI

Exclusion Criteria:

  • epistaxis
  • suspected or confirmed skull or nasal fracture
  • Moderate to severe traumatic brain injury
  • hemodynamically unstable
  Contacts and Locations
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Please refer to this study by its identifier: NCT01402596

University of Sao Paulo
Sao Paulo, SP, Brazil, 05508000
Sponsors and Collaborators
University of Sao Paulo
Study Director: Eduardo Mekitarian Filho, MSc University of Sao Paulo
  More Information

Responsible Party: Eduardo Mekitarian Filho, University of Sao Paulo Identifier: NCT01402596     History of Changes
Other Study ID Numbers: USP-Sed-001
Study First Received: July 19, 2011
Last Updated: June 19, 2013

Keywords provided by University of Sao Paulo:
Deep Sedation
Emergency Hospital Services
Chloral hydrate
Randomized controlled trial

Additional relevant MeSH terms:
Brain Injuries
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Wounds and Injuries
Chloral Hydrate
Adjuvants, Anesthesia
Hypnotics and Sedatives
Central Nervous System Depressants
Physiological Effects of Drugs
Anti-Anxiety Agents
Tranquilizing Agents
Psychotropic Drugs
Anesthetics, Intravenous
Anesthetics, General
GABA Modulators
GABA Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action processed this record on April 28, 2017