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Objective • This study aimed to compare the effectiveness of prehospital emergency treatments using midazolam (MDL) intramuscularly, diazepam (DZP) enema, and chloral hydrate (CH) enema in managing pediatric convulsions. Methods • A comparative observational study was conducted, and a total of 140 children with acute convulsions treated with prehospital anti-convulsions at Qinhuangdao First Hospital’s emergency department between June 2015 and May 2019 were included in this study. The children were categorized based on the prehospital anti-convulsion measures received: group M (n = 48) received MDL intramuscularly, group D (n = 46) received DZP enema, and group C (n = 46) received CH enema. The emergency effects of the three treatment groups were compared. Results • 1. Group M showed significantly shorter treatment preparation time and total rescue time compared to groups C and D (both P < .05); no significant difference was observed between groups C and D (both P>.05), including convulsion control time in the effective cases (45 in group M, 42 in group C, and 43 in group D) (all P>.05 Group M had effective rates of 93.75%, while group C and group D had rates of 91.3% and 93.48%, respectively (all P > .05); Group M had more controlled cases at 1 min, 3 min, 5 min, and 10 min than group C and group D (all P>.05). Group M had significantly fewer relapses, cases requiring intravenous maintenance treatment, and faster convulsion control after intravenous maintenance compared to groups C and D (P < .05), with no significant differences between groups C and D in time to recovery of consciousness and length of hospitalization (P>.05). 4. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory (R) frequency, and peripheral oxygen saturation (SpO2 ) showed no significant differences before and 10 minutes after medication in all three groups (P>.05); SBP and DBP levels fluctuated within the normal range, while HR decreased, R frequency decreased, and SpO2 increased significantly 10 minutes after medication compared to before treatment (P<.05). 5. No significant adverse effects were observed in the three patient groups. Conclusions • MDL intramuscular injection, DZP enema, and CH enema were effective prehospital treatments for pediatric acute convulsions. MDL intramuscular injection demonstrated advantages such as fast onset, reliable efficacy, ease of use, and high safety, making it more suitable for the prehospital treatment of pediatric convulsions. [ABSTRACT FROM AUTHOR]

Background: During computed tomography (CT) examinations, the presence of radiation material undoubtedly has a certain impact on patients, particularly children, who are more susceptible to radiation. Consequently, finding ways to minimize radiation dosage and mitigate radiation-related risks while enhancing the quality and accuracy of CT scans has become a crucial concern for medical professionals in CT equipment manufacturing companies and radiology departments to contemplate. Objectives: This study aimed to explore the feasibility of low dose and low contrast medium combined with low flow rate scanning in CT angiography (CTA) of children's liver. Patients and Methods: A total of 59 children who visited our department for liver vascular CT scans between April 2021 and December 2022 were prospectively selected and randomly divided into 2 groups: the experimental group and the control group. The experimental group consisted of 28 children who received an injection of 80 kV, automatic tube current, low contrast dose (1.5 mL/kg), and low flow rate of 20 s. The control group included 31 children who were injected with 100 kV, automatic tube current, contrast agent dose (2 mL/kg), and flow rate of 16 s. The objective and subjective image quality, radiation dose, and iodine intake in the arterial, portal, and venous phases were compared between the 2 groups. Results: During the arterial, portal, and venous phases, the experimental group exhibited lower signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) compared to the control group (P < 0.05). However, there was no significant difference in subjective quality scores between the 2 groups (P> 0.05). The effective dose (ED), volume CT dose index (CTDIvol), and dose-length product (DLP) of the experimental group were lower than those of the control group (P< 0.05). Additionally, the iodine intake in the experimental group was lower than that in the control group (P < 0.05). Conclusion: In the examination of hepatic vascular CTA in children, the use of a 3-low scanning technique can effectively decrease radiation and contrast agents while ensuring sufficient image quality for accurate clinical diagnosis. [ABSTRACT FROM AUTHOR]

The author criticizes the use of chloral hydrate for refinement in animal experimentation and euthanasia. He explains the principles of replacement, reduction and refinement that provide an ethical framework for the use of research animals and improving their welfare. He describes factors behind the continued use of chloride hydrate as a sedative, hypnotic or anaesthetic agent. He discusses reasons for its unethical use for euthanasia and the availability of more refined choices.

Objectives Sedation and stability during electroencephalography (EEG) in pediatrics have high clinical importance. This study compares the sedative properties of oral chloral hydrate (OCH) and intranasal fentanyl (INF). Materials & Methods This study was a randomized clinical trial conducted in 2020 in Isfahan City on sixty-two pediatric candidates for EEG. Patients were randomized into two groups receiving 50 mg/kg OCH and 2 µg/kg INF thirty minutes before the process. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and oxygen saturation (O2 sat) of patients, sedation, and physician's satisfaction were measured and compared between groups. Results The HR of patients decreased significantly in both groups (P< 0.001), and the patients that received INF had significantly lower HR 15, 30, 45, and 60 minutes after drug administrations (P< 0.05). RR evaluation indicated significantly decreased RR in both groups (P< 0.001), and patients receiving INF had lower RR 30, 45, and 60 per minutes after drug administrations (P< 0.001). Both groups showed significantly increased sedation levels during the study (P< 0.001), and patients treated with INF had higher sedation levels 15, 30, and 45 minutes after drug administration. Satisfaction rates were higher among the group that received INF (P= 0.020). Conclusion The use of INF had significant analgesic and sedative effects on pediatrics undergoing EEG. [ABSTRACT FROM AUTHOR]

Background: Chloral hydrate is a sedative-hypnotic drug widely used for relieving fear and anxiety in pediatric patients. However, mechanisms underlying the chloral hydrate-mediated analgesic action remain unexplored. Therefore, we investigated the effect of 2′,2′,2′-trichloroethanol (TCE), the active metabolite of chloral hydrate, on tetrodotoxin-resistant (TTX-R) Na+ channels expressed in nociceptive sensory neurons. Methods: The TTX-R Na+ current (INa) was recorded from acutely isolated rat trigeminal ganglion neurons using the whole-cell patch-clamp technique. Results: Trichloroethanol decreased the peak amplitude of transient TTX-R INa in a concentration-dependent manner and potently inhibited persistent components of transient TTX-R INa and slow voltage-ramp-induced INa at clinically relevant concentrations. Trichloroethanol exerted multiple effects on various properties of TTX-R Na+ channels; it (1) induced a hyperpolarizing shift on the steady-state fast inactivation relationship, (2) increased use-dependent inhibition, (3) accelerated the onset of inactivation, and (4) retarded the recovery of inactivated TTX-R Na+ channels. Under current-clamp conditions, TCE increased the threshold for the generation of action potentials, as well as decreased the number of action potentials elicited by depolarizing current stimuli. Conclusions: Our findings suggest that chloral hydrate, through its active metabolite TCE, inhibits TTX-R INa and modulates various properties of these channels, resulting in the decreased excitability of nociceptive neurons. These pharmacological characteristics provide novel insights into the analgesic efficacy exerted by chloral hydrate. [ABSTRACT FROM AUTHOR]

The article reports that statistician Richard Gill and colleagues detailed the statistical missteps in past medical murder trials and made recommendations for how legal systems for the alleged murder of seven babies and attempted murders in a neonatal unit at the Countess of Chester Hospital. It mentions that Investigators had found traces of the heart medication digoxin in the body of one alleged victim and an overdose of the sedative chloral hydrate with different mortality rates.

Purpose: This study investigated correlations between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients. Methods: With parental consent, 84 children who were placed under moderate or deep sedation with chloral hydrate for examinations from November 19, 2020 to July 9, 2022 were recruited. Results: Patients' average age was 19.9 months. Pediatric neurology patients and those who underwent electroencephalography took significantly longer to achieve sedation with chloral hydrate. There was a negative correlation between the time to achieve sedation and actual sleep time within 24 hours prior to the examination. Positive correlations were found between the actual sleep time 24 hours prior to the examination and the second dose per weight, as well as between the sedation recovery time and awake hours before the examination. Conclusion: Sleep restriction is not an effective adjuvant therapy for chloral hydrate sedation in children, and sedation effects vary according to pediatric patients' characteristics. Therefore, it would be possible to reduce the unnecessary efforts of caregivers who restrict children's sleep for examinations. It is more important to educate parents about safe sedation than about sleep restriction. [ABSTRACT FROM AUTHOR]

The electrochemical behavior of chloral hydrate in aqueous solutions at various pH values was investigated by using polarography. Reduction of chloral hydrate takes place in two steps: one appears as a small limiting current value that corresponds to the reduction of the unhydrated form, present in solutions in less than 3%, and another larger limiting current value at more negative potentials corresponding to a reduction of C‐Cl bonds in the hydrated form. Reduction schemes for both the hydrated and unhydrated forms and of an oxidation process for chloral hydrate are proposed. The reduction scheme supports the stepwise removal of chloride ions from the hydrated form of chloral that is electroactive in its protonated form, yielding ethanol as the final product. A rate constant for the protonation of chloral hydrate is calculated from its measured pKa value and electrochemical data. The role of hydration‐dehydration equilibria involving the reduction intermediates, which are reduced at more negative potentials than that of chloral, was concluded based on a comparison of limiting currents of chloral hydrate with those of 2,2,2‐trichloroethanol. The alcohol yields, in medium pH range a diffusion‐limited current, corresponding to cleavage of three C‐Cl bonds. This allowed the calculation of the equilibrium constant of the hydration‐dehydration equilibria. [ABSTRACT FROM AUTHOR]

Auguste Béhal (1859-1941) was a French pharmacist that developed the chemistry of 2derivatives and studied the composition of vegetable creosotes, the decomposition of chloral, and the preparation and properties of asbolin. These studies led to the synthesis of a large number of new organic compounds, several of them with therapeutic value. [ABSTRACT FROM AUTHOR]

Objectives This 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. Materials & Methods This double-blind clinical trial study was conducted on 70 leukemic and nonleukemic patients aged 3-11 years. The patients were divided into four groups. In group A, chloral hydrate solution was given to 18 patients. In group B, hydroxyzine syrup was used for 18 patients. In group C, chloral hydrate solution and lidocaine/prilocaine cream were used for 17 patients. In group D, hydroxyzine syrup and lidocaine/ prilocaine cream were used for 17 patients. These groups were assessed and judged based on the visual analog scale (VAS). The side effects of the drugs were also recorded. Results In this study, 54.3% (n=38) and 45.7% (n=32) of the cases were female and male, respectively. Furthermore, 77%, 7.2%, and 15.8% of the cases were reported with acute lymphocytic leukemia, acute myeloid leukemia, and infectious disease, respectively. The VAS results showed no difference in these four groups. Nontraumatic lumbar puncture (LP) (red blood cell<50) was observed in 97.1% of the cases. Conclusion Although premedications for LP with hydroxyzine syrup and chloral hydrate solution were not statistically effective in pain relief, they increased patient and parent satisfaction. Moreover, adding lidocaine/ prilocaine cream does not improve the effectiveness of the drugs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Faculty of Pharmacy of Ankara University / Ankara Üniversitesi Eczacilik Fakültesi Dergisi is the property of Ankara University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The lack of appropriate medicines for children has a significant impact on health care practices in various countries around the world, including Thailand. The unavailability of pediatric medicines in hospital formularies causes issues regarding off-label use and extemporaneous preparation, resulting in safety and quality risks relating to the use of medicines among children. This research aimed to identify missing pediatric formulations based on the experience of healthcare professionals in a teaching hospital in northern Thailand. A cross-sectional survey was conducted to collect data on missing pediatric formulations, the reasons for their inaccessibility, their off-label uses, their reactions to the situation, and suggestions to improve access to these identified medications. The survey was distributed to all physicians, nurses, and pharmacists involved in prescribing, preparing, dispensing, and administering pediatric medicines. A total of 218 subjects responded to the survey. Omeprazole, sildenafil, and spironolactone suspension were most often identified as missing formulations for children by physicians and pharmacists. They are unavailable on the Thai market or in any hospital formulary. For nurses, sodium bicarbonate, potassium chloride, and chloral hydrate were the most problematic formulations in terms of preparation, acceptability, and administration. These medicines were difficult to swallow because of their taste or texture. [ABSTRACT FROM AUTHOR]

The synthesis of 6-chloro-(dichloro-, trichloro)methyl-3-R-6,7-dihydro-2H-[1.2.4] triazino[2,3-c]quinazolin-2-ones and their modification under the action of nucleophilic and/or basic reagents are described in this article. It was shown that 6-chloro-(dichloro-, trichloro)methyl-3-R-6,7-dihydro-2H-[1,2,4]triazino[2,3-c]quinazolin-2-ones can be prepared by cyclocondensation of 3-(aminophenyl)-6-R-1,2;4-triazine-5(2W)-ones with chloro-(dichloro-)acetaldehyde or chloral hydrate. The reactivity of the synthesized compounds toward nucleophilic base morpholine and non-nucleophilic base diisopropylethylamine (DIPEA) under different conditions was studied. It was shown that the prepared compounds under the action of morpholine and/or DIPEA can be converted into the products of substitution, elimination or elimination followed by isomerization and substitution. Refluxing of 6-(chloromethyl)-3-R-6,7-dihydro-2 H-[1.2.4] triazino[2,3-c]quinazoline-2-ones with equimolar quantity of morpholine and 10% excess of DIPEA in ethylene glycol monoethyl ether (EGEE) yielded the products on N-alkylation. 6-(Morpholinomethyl)-3-R-2 H-[1,2,4]triazino[2,3-c]quinazoline-2-ones were obtained by heating of 6-dichloromethyl-3-R-6,7-dihydro-2H-[1,2,4]triazino[2,3-c]quinazoline-2-ones with five-fold excess of morpholine in EGEE. Reaction of 3-R-6-(trichloromethyl)-6,7-dihydro-2 H-[1,2,4]triazino[2,3-c]quinazolin-2-ones with three-fold excess of DIPEA in EGEE yielded 3-R-2#-[1,2,4]triazino[2,3-c]quinazoline-2-ones. The physicochemical and spectral characteristics of the prepared compounds were determined and discussed. [ABSTRACT FROM AUTHOR]

Neurodiagnostic investigation requirements are expanding for diagnostic and therapeutic purposes in children, especially in those with developmental delay/intellectual disability (DD/ID). Thus, determination of optimal sedatives to achieve successful sedation and immobility without further neurological compromise is important in children with DD/ID. The purpose of this study is to assess the effectiveness and adverse reactions of chloral hydrate (CH) for brain magnetic resonance imaging (B-MRI) in children with DD/ID compared to those with normal intelligence (NI). We performed a retrospective chart review of children aged from 1 day to 12 years who required elective sedation using CH for B-MRI. About 730 cases (415 with DD/ID and 315 with NI) of CH sedation were conducted for B-MRI. Children with DD/ID showed a higher failure rate (22%) than did those with NI (6%); additional CH and prolonged sedation time were required. There was no difference in incidence of adverse reactions between DD/ID and NI groups (p = 0.338). Older or heavier children with DD/ID (p = 0.036 and p = 0.013, respectively), as well as those diagnosed with epilepsy or neuropsychiatric disorders showed higher risk of sedation failure (p < 0.001 for each). In conclusion, CH was a suboptimal sedative drug for children with DD/ID compared with those with NI. Other alternative or supplementary sedatives should be taken into consideration especially for those vulnerable groups. [ABSTRACT FROM AUTHOR]

The synthesis of previously unattainable 2,5-disubstituted 4,5-dihydroimidazo[1,5-b]pyrazol-6-ones has been developed. Electrochemical reductions of readily available 2,2,2-trichloroethylideneacetophenones were followed by reaction with hydrazine, leading to 3-aryl-5-dichloromethyl-2-pyrazolines. These were treated with isocyanates to obtain the corresponding aminocarbonyl derivatives, which were found to be able to form an otherwise almost inaccessible imidazo[1,5-b]pyrazole ring system via a one-step reaction involving internal condensation followed by hydrogen chloride elimination and aromatization. The molecular­ structures of 2-(4-methylphenyl)-5-tosyl-4,5-dihydro­imidazo[1,5-b]pyrazol-6-one, 5-dichloromethyl-N-(4-chlorophenyl)-4,5-dihydro-3-p-tolylpyrazole-1-carboxamide, and 5-(4-bromophenyl)-2-p-tolyl-4,5-dihydroimidazo[1,5-b]pyrazol-6-one were determined by X-ray crystallographic analysis.

Objective: To improve success rates of children requiring sedation for MRI.Methods: Audits of sedation success for children attending planned MRI using three different approaches: (1) National Institute for Health and Care Excellence (NICE) guidance (chloral hydrate if <15 kg and oral midazolam if ≥15 kg), (2) Chloral hydrate for all patients, (3) Chloral hydrate±intranasal dexmedetomidine if <15 kg and intranasal dexmedetomidine alone if ≥15 kg.Results: 74 patients had 85 MRI scan attempts. Overall success rates were significantly higher when using intranasal dexmedetomidine compared with following NICE guidance (81% vs 52% p=0.017). Dexmedetomidine performed better than oral midazolam for the same indication (76% vs 33% p=0.026). The side effect profile for dexmedetomidine was as reported in larger studies.Conclusions: Intranasal dexmedetomidine is an effective alternative to oral midazolam for sedation for MRI and as a rescue medication where chloral hydrate has been ineffective. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Tabriz University of Medical Sciences is the property of Tabriz University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: This systematic review and meta-analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room.Methods: Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure.Results: We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives.Conclusion: Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures. [ABSTRACT FROM AUTHOR]

Brief Overview: The use of chloral hydrate as the primary sedation agent has declined across the nation after commercial production of the liquid formulation ceased. Although alternative sedatives have gained popularity, some pharmacies have continued to provide oral chloral hydrate by compounding it from raw ingredients. Thus, oral chloral hydrate use has continued in children despite the availability of alternative effective agents. Objective: The purpose of this investigation was to evaluate institutional chloral hydrate utilization as the primary agent for procedural sedation. Design/Methods: We conducted a retrospective study of patients given chloral hydrate for procedural sedation from October 2010 to December 2016. The hospital pharmacy database of chloral hydrate use at our 2 free-standing children's hospitals was reviewed and matched to procedure billing data. Results: There were 5874 chloral hydrate administrations for procedural sedation during the study period. The highest rates of use occurred in 2014, when there were 1420 chloral hydrate orders within our hospital. The large majority of sedations were for cardiac studies/procedures (n = 4250, 72.4%). Conclusions: Despite significant declines in use of chloral hydrate for procedural sedation across the country, local utilization of oral chloral hydrate remains high. Recent declines may be due to high-use clinical sites transitioning to alternative sedatives such as intranasal dexmedetomidine. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pediatric subspecialists routinely provide procedural sedation outside the operating room. No large study has reported trends in outpatient pediatric procedural sedation. Our purpose in this study was to identify significant trends in outpatient procedural sedation using the Pediatric Sedation Research Consortium. METHODS: Prospectively collected data from 2007 to 2018 were used for trending procedural sedation. Patient characteristics, medications, type of providers, serious adverse events, and interventions were reported. The Cochran-Armitage test for trend was used to explore the association between the year and a given characteristic. RESULTS: A total of 432 842 sedation encounters were identified and divided into 3 4-year epochs (2007-2011, 2011-2014, and 2014-2018). There was a significant decrease in infants <3 months of age receiving procedural sedation (odds ratio = 0.97; 95% confidence interval, 0.96-0.98). A large increase was noticed in pediatric hospitalists providing procedural sedation (0.6%-9.5%; P < .001); there was a decreasing trend in sedation by other providers who were not in emergency medicine, critical care, or anesthesiology (13.9%-3.9%; P < .001). There was an increasing trend in the use of dexmedetomidine (6.3%-9.3%; P < .001) and a decreasing trend in the use of chloral hydrate (6.3%-0.01%; P < .001) and pentobarbital (7.3%-0.5%; P < .001). Serious adverse events showed a nonsignificant increase overall (1.35%-1.75%). CONCLUSIONS: We report an increase in pediatric hospitalists providing sedation and a significant decrease in the use of chloral hydrate and pentobarbital by providers. Further studies are required to see if sedation services decrease costs and optimize resource use. [ABSTRACT FROM AUTHOR]

Objective One of the difficulties to conduct electroencephalography (EEG) in pediatric patient population is that they are not always cooperative during the procedure. Different medications are used to induce sedation during EEG recording. In order to find a medication with the least adverse effects and high efficacy; the current study aimed at comparing clonidine and chloral hydrate as a premedication prior to EEG recording in pediatric population. Materials & Methods A prospective, randomized, single-blinded, controlled trial was conducted on 198 children (9 to 156 months old) to investigate the sedative and adverse effects of clonidine and chloral hydrate. Patients, partially sleep-deprived the night before, were randomly divided into two groups of clonidine (n=100) and chloral hydrate (n=98) on an alternative day basis. Results The average sleep onset latency was significantly longer in the clonidine group than chloral hydrate group (the Mann-Whitney test, p <0.0001). Sleep duration ranged 15 to 150 minutes and it was not significantly different between the two groups (the Mann-Whitney test, p = 0.2). Drowsiness terminated faster with chloral hydrate than clonidine. Drowsiness after arousal was observed in 58% and 26.1% of patients in the clonidine and chloral hydrate groups, respectively; the difference between the groups was significant (the Mann-Whitney test, p = 0.058). EEG results were reported normal in 77 subjects in the chloral hydrate group (77%) and 69 subjects (69%) in the clonidine group (p = 0.161). Generalized epileptiform discharges were significant in the clonidine group (the Mann-Whitney test, p = 0.006). Conclusion The results of the current study showed that both 5% chloral hydrate (1 mL/kg) and clonidine (4 μg/kg) could be administered as a premedication prior to EEG recording in children, although drowsiness after arousal was higher with clonidine than chloral hydrate. However, the yield of generalized epileptiform discharges in the clonidine group was greater than that of the chloral hydrate group. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare the efficacy and safety of aerosolized intranasal midazolam (INM) compared to oral chloral hydrate (OCH) as procedural sedatives in pediatric patients undergoing computed tomography (CT) imaging. Materials and Methods: A prospective, randomized, double-blind clinical trial was utilized in children aged 1 to 8 years who presented to the ED with minor head trauma and were scheduled to undergo brain CT scan. One hundred and sixty children were randomized to receive INM 0.3 mg/kg with oral placebo or 75 mg/kg OCH with intranasal placebo. If the patient was not adequately sedated 20 minutes after the initial dose, a second dose of the same medication at one-third of the initial dosage was given. The sedation level of patients after drug administration was assessed using the Ramsay sedation scale. Results: Both groups were comparable with respect to age, male to female ratio, weight, and baseline vital signs. Sixty two children (77.50%) in the INM group and 59 children (73.42%) in the OCH groups reached a Ramsay score of four, respectively (p=0.55). There was no significant difference in regards to the time to become adequately sedated (21.32±6.54 vs 23.62±7.40, p=0.173) and time for completing CT scan (30.37±7.18 vs 32.96±7.85, p=0.185). However, the time to recovery was shorter for the INM group (72.52±10.17 vs 88.10±10.27, p=0.001). No serious side effects were seen in the study groups (p=0.836). The majority of parents were somewhat to very satisfied, 83.54% and 81.25% in the OCH and INM groups, respectively (p=0.928). Conclusion: INM can be used to sedate children between 1 to 8 years who are to undergo CT imaging of brain with a comparable rate of efficacy and safety to OCH. [ABSTRACT FROM AUTHOR]

Using chloral hydrate carries a risk of adverse events and compounding errors, and much of the available literature recommends using alternative sedatives for pediatric patients. But evidence regarding the efficacy of chloral hydrate and of alternative agents is conflicting. [ABSTRACT FROM AUTHOR]

Lactic acid (LA) is a sensitive indicator of exercise intensity and duration. A single bout of prolonged and intensive exercise can cause transient immunosuppression through the interaction of cellular, humoral, and hormone factors. Exercise-induced influences on neutrophil extracellular traps (NETs) release have been reported, but the underlying mechanism is unknown. This study investigated NETs release, cell-free DNA (cf-DNA), and LA concentration in mice after 60 and 145 min of intensive, graded treadmill running. The concentration of LA and cf-DNA increased, while the level of myeloperoxidase-DNA (MPO-DNA) (an indicator of NETs release) decreased during 145 min of exhaustive running. LA was positively and negatively correlated with cf-DNA and MPO-DNA (R 2 = 0.57 and 0.53, respectively, both p < 0.001). Subsequent in vitro experiments were conducted with neutrophils activated by phorbol myristate acetate (PMA) in the presence of LA at different concentrations. Increasing LA concentrations were associated with decreases in NETs release and reactive oxygen species (ROS) formation. Taken together, this work furthers our understanding of how NETs and oxidative reaction respond to one bout of prolonged and intensive running. The data support a negative relationship between LA accumulation and NETs release after heavy exertion. [ABSTRACT FROM AUTHOR]

Chloral hydrate (CH) poisoning is not commonly seen in the emergency department. CH is a commonly prescribed sedative agent for various day care procedures despite its toxic profile even when other safe sedative medications are available. We report a case of CH poisoning that manifested with neurotoxicity followed by cardiotoxicity leading to cardiac arrest. With a high index of suspicion and proper management, our patient was discharged with normal neurological outcome. In this case report, we discuss CH poisoning and toxicity with highlights on specific intervention including β-blockers. CH induced arrhythmias have been reported to be refractory to the standard antiarrhythmic medications and respond well to β-blockers. [ABSTRACT FROM AUTHOR]

Background: In 2013, outpatient use of chloral hydrate (CH) was limited and other alternatives such as oral pentobarbital (PB) were explored to achieve conscious sedation in young children for transthoracic echocardiography (TTE). We aimed to assess efficacy and safety of the two medications. Methods: Clinical information, from a computerized database, about children who received sedation with either CH or PB for TTE at our center (2008–2015) was reviewed, and the two groups were compared for sedation effectiveness and complications. Results: Three thousand eight hundred fifty one pediatric patients (median age 8 months) underwent conscious sedation during TTE (mean doses CH 50 mg/kg, PB 4 mg/kg). Demographic characteristics of the two groups were similar. Sedation failure rate (CH 2.4%, PB 2.9%, P = NS), need for supplemental doses (CH 17.9%, PB 16.2%, P = NS), and overall adverse event rate (PB 1.4%, CH 1.9%; P = NS) were similar in the two groups. There were fewer episodes of respiratory depression with PB (0.3% vs 1.6%, P < 0.05). The rate of paradoxical reactions was higher with PB (1% vs 0.03%, P < 0.05). Increasing age predicted the need for supplemental doses and for sedation failure in both groups. Neonates (7.5% vs 0%) and infants (2% vs 0.6%) given CH were more likely to develop adverse reactions. Conclusion: Chloral hydrate and PB are equally effective. However, CH is associated with an increased incidence of transient desaturation, while PB is associated with an increased incidence of a paradoxical reaction. Increasing age is predictive of the need for supplemental doses and for failure of sedation in both groups. [ABSTRACT FROM AUTHOR]

To assess whether Fosl1 is a suitable parameter for wound age estimation, a total of 126 male Sprague-Dawley rats were divided into control (n = 6 per group), contusion (including 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48 h post-severe injury, and 4 or 8 h post-moderate or -mild injury subgroups), and post-mortem (including 6, 12, 18, and 24 h subgroups) groups (n = 6 per subgroup). A contusion was produced in the right limb of the rats using the drop-ball technique (under intraperitoneal chloral hydrate anaesthesia), and the animals were sacrificed using a lethal dose of pentobarbital. The expression of Fosl1 mRNA and protein was determined in the contused and contralateral uninjured muscle and post-mortem specimens of musculi quadriceps femoris using real-time PCR and western blotting, respectively. Compared with the control group, the expression of Fosl1 mRNA was increased in several contused and contralateral uninjured muscles, and decreased in post-mortem groups (P<0.05). The expression of Fosl1 protein was increased in the 4, 8, 32, 36, 40, 44, and 48 h contusion subgroups (P<0.05), but there was no significant change in the contralateral uninjured muscles and post-mortem specimens. The results indicated that Fosl1 protein was more specific and stable than Fosl1 mRNA, which suggests that the temporal expression, systematic response, and post-mortem stability should be comprehensively analysed when exploring other markers for use in wound age estimation in the future. [ABSTRACT FROM AUTHOR]

Abstract Chloral hydrate (CH) is a common disinfection by-product found in treated water, and its effective control is important to human health. This study evaluated the effects of some environmental factors (e.g., pH, CH dosage, typical ions) and operational variables (e.g., lamp power, irradiation time) on CH photolysis efficiency via low-pressure mercury lamp–induced ultraviolet (LPUV) at 254 nm. The results demonstrated that the photolysis rate increased significantly with increasing pH from 7.0 to 10.5 and lamp power from 6 to 12 W. Meanwhile, the presence of nitrate, iodide, or free chlorine facilitated CH photolysis, whereas the existence of natural organic matter hindered the process. Together, these factors may help explain varying CH photolysis in different types of waters: seawater > ultrapure water > tap water > lake water. In addition, the initial CH dosage also played an important role, with higher CH being degraded more slowly. Mechanistically, although no catalyst or oxidant was added, CH photolysis was to some extent inhibited by a hydroxyl radical quencher, tert -butyl alcohol, suggesting that indirect photolysis was also responsible for CH loss. In terms of reaction products, the CH photolysis yielded primarily chloride ions and carbon dioxide, thus supporting mineralization as the key pathway. The results may help better understand the control of CH in water using UV. Graphical abstract Image 1 Highlights • Factors affecting chloral hydrate (CH) photolysis by UV254 were evaluated. • CH photolysis increased with higher pH & lamp power but lower concentration (C 0). • Both direct photolysis and indirect photolysis were responsible for the CH loss. • CH photolysis yielded chloride ions and carbon dioxide as key products. [ABSTRACT FROM AUTHOR]

Objective: To study the short-term effects of a single-dose chloral hydrate on neonatal auditory perception by measuring auditory event-related potentials (aERPs). Methods: Thirty-nine full-term neonates, aged 2–28 days and weighing 2980–4350 g, were divided into two groups including a chloral hydrate group (CH group, n = 17) and a non-chloral hydrate control group (non-CH group, n = 22). The CH group was given single-dose chloral hydrate (30 mg/kg) orally before aERPs measurement. An auditory oddball paradigm was used to elicit aERPs. P2 and N2 components of the ERP were recorded from electrodes at the Fz and Cz locations, and the areas under their curves (P2 and N2 areas) were calculated for the comparison between two groups. Results: Significant differences was found in the P2 area between the two groups at Fz and Cz (Fz: F (1,37) = 487.75, P < 0.05; Cz: F (1,37) = 1465.94, P < 0.05). Similarly, significant difference was also in the N2 area between the two groups at both locations (Fz: F(1,37) = 153.38, P < 0.05; Cz: F(1,37) = 798.42, P < 0.05). Conclusion: A single-dose of chloral hydrate impacts neonatal auditory perception in the short-term. Long-term effects will also be studied in future. [ABSTRACT FROM AUTHOR]

Abstract Phenolic moieties in natural organic matter (NOM) are important precursors of disinfection by-products (DBPs). In this study, the formation of chloral hydrate from chlorination of seventeen phenolic compounds, including mono-, di- and tri-hydroxybenzenes, were evaluated and the role of chlorine dioxide (ClO 2) pre-oxidation on its formation pathways was explored. Chloroform, was also evaluated for comparison. Chlorination of resorcinol exhibited the highest chloral hydrate yield (2.83 ± 0.13%) followed by chlorination of 2,4,6-trichlorophenol (0.61 ± 0.03%). The median of chloral hydrate yields from the tested phenolic compounds was 0.22%. ClO 2 pre-oxidation reduced the yields of chloroform from phenol derivatives by 37–97%, except 4-methoxyphenol, catechol and 2,3-dihydroxyphenol. On the contrary, ClO 2 pre-oxidation of di- and tri-hydroxybenzenes tended to increase chloral hydrate yields in post-chlorination. Mixed results (both increases and decreases) were observed in chloral hydrate formation from chlorination of mono-hydroxybenzenes after ClO 2 pre-oxidation. The changes of their formation were dependent on ClO 2 pre-oxidation time and dosages. Identification of transformation products suggested that phenolic compounds were mainly converted to unsaturated carbonyl structures by ClO 2. Chlorine substituted benzoquinones and cyclopent-4-ene-1,3-diones were important transformation products after a series of ring open, decarboxylation, hydrolysis and chlorine substitution reactions. The changes in the formation yields of chloral hydrate and chloroform were governed by the difference in initial phenolic precursors and the transformation products after ClO 2 pre-oxidation. ClO 2 pre-oxidation in water treatment can effectively reduce chloroform formation but may have a risk of increasing chloral hydrate formation. Graphical abstract Image 1 Highlights • CH yield for chlorination of 17 phenols with(out) ClO 2 pre-oxidation was evaluated. • Phenols substituted by electron-withdrawing groups generally have higher CH yields. • ClO 2 pre-oxidation of di/tri-hydroxybenzenes can increase CH yield in chlorination. • ClO 2 oxidation changed CH formation pathway via unsaturated ketone intermediates. [ABSTRACT FROM AUTHOR]

An aqueous solution of pH indicator Resazurin dye (RZ) with and without containing chloral hydrate as an additive substance was studied for use as a liquid dosimeter. The dosimeter covers a range extended from 50 to 650 Gy depending on the concentration of both dye and chloral hydrate. Some of the properties about the dosimetry behavior were studied: its response to irradiation, the stability of dosimeter before and after irradiation, and an effect of different acidity on the response curve, G-value, the uncertainty of the measurement. All the recorded values encourage using this dosimeter in many sensitive dose applications. [ABSTRACT FROM AUTHOR]

OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative. [ABSTRACT FROM AUTHOR]

Summary: Background: Moderate to deep sedation is required for an auditory brainstem response test when high‐intensity stimulation is used. Chloral hydrate is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric non‐painful procedural sedations. Objective: The aim of this study was to compare the sedation success rate after oral chloral hydrate at 50 mg kg−1 and intranasal dexmedetomidine at 3 μg kg−1 plus buccal midazolam at 0.1 mg kg−1 for an auditory brainstem response test. Methods: Children who required an auditory brainstem response test were recruited and randomly assigned to receive oral chloral hydrate at 50 mg kg−1 and intranasal placebo, or intranasal dexmedetomidine at 3 μg kg−1 with buccal midazolam 0.1 mg kg−1. The primary outcome was the rate of successful sedation for auditory brainstem response tests. Results: Fifty‐seven out of 82 (69.5%) were successfully sedated after chloral hydrate, while 70 out of 78 (89.7%) children were successfully sedated with dexmedetomidine plus midazolam combination, with the odd ratio (95% CI) for successful sedation between dexmedetomidine plus midazolam combination and chloral hydrate estimated to be 3.84 (1.61‐9.16), P = 0.002. Dexmedetomidine plus midazolam was associated with quicker onset with median onset time 15 (IQR 11.0‐19.8) for dexmedetomidine plus midazolam and 20 (IQR 15.0‐27.0) for chloral hydrate respectively, with difference between median (95% CI) of 5 [3‐8], P < 0.0001). The behavior observed during drug administration of intranasal dexmedetomidine and buccal midazolam was better that of the children who had oral chloral hydrate. No children required oxygen therapy or medical intervention for hemodynamic disturbances in this study and the incidence of hypotension and bradycardia was similar. Conclusion: Intranasal dexmedetomidine plus buccal midazolam was associated with higher sedation success with deeper level of sedation, with similar discharge time and adverse event rate when compared to chloral hydrate. [ABSTRACT FROM AUTHOR]

We synthesized five novel tryptamine derivatives characterized by the presence of an azelayl chain or of a 1,1,1-trichloroethyl group, in turn connected to another heterocyclic scaffold. The combination of tryptamin-, 1,1,1-trichloroethyl- and 2-aminopyrimidinyl- moieties produced compound 9 identified as the most active compound in hematological cancer cell lines (IC50 = 0.57–65.32 μM). Moreover, keeping constant the presence of the tryptaminic scaffold and binding it to the azelayl moiety, the compounds maintain biological activity. Compound 13 is still active against hematological cancer cell lines and shows a selective effect only on HT29 cells (IC50 = 0.006 µM) among solid tumor models. Compound 14 loses activity on all leukemic lines, while showing a high level of toxicity on all solid tumor lines tested (IC50 0.0015–0.469 µM).

The reaction of chloral or dichloro(phenyl)acetaldehyde N -arylsulfonylimines with cyclopentadiene, depending on the reaction conditions, affords either Diels–Alder adducts, 2-arylsulfonyl-2-azabicyclo[2.2.1]hept-5-enes, or unexpectedly new amidoalkylated derivatives of cyclopentadiene, N -[(cyclopentadienyl)(polychloromethyl)methyl]arenesulfonamides. [ABSTRACT FROM AUTHOR]

Paediatric sedation is used in Starship Radiology and wards in Auckland as an important method to gain the best possible images without need for a general anaesthetic. The safe use, dosage and assessment criteria for chloral hydrate and midazolam for paediatric sedation is discussed. [ABSTRACT FROM AUTHOR]

Gel dosimeters are attractive detectors for radiation therapy, with properties similar to biological tissue and the potential to visualize volumetric dose distributions. Radio-fluorogenesis is the yield of fluorescent chemical products in response to energy deposition from ionizing radiation. This report shares the development of a novel radio-fluorogenic gel (RFG) dosimeter, gelatin infused with coumarin-3-carboxlyic acid (C3CA), for the quantification of imparted energy. Aqueous solutions exposed to ionizing radiation result in the production of hydroxyl free radicals through water radiolysis. Interactions between hydroxyl free radicals and coumarin-3-carboxylic acid produce a fluorescent product. 7-hydroxy-coumarin-3-carboxylic acid has a blue (445 nm) emission following ultra-violet (UV) to near UV (365-405 nm) excitation. Effects of C3CA concentration and pH buffers were investigated. The response of the RFG was explored with respect to strength, type, and exposure rate of high-energy radiation. Results show a linear dose response relationship independent of energy and type, with a dose-rate dependency. This report demonstrates increased photo-yield with high pH and the utility of gelatin-RFG for phantom studies of radiation dosimetry. [ABSTRACT FROM AUTHOR]

Objective: To explore the toxicity of multi-walled carbon nanotubes (MWCNTs) on the liver lipid metabolism of offspring mice and the possible mechanisms involved. Method: Virgin female (16–18 g) and male (18–20 g) C57BL/6 mice were randomly divided into two groups: Control group and Test group. After anesthesia with chloral hydrate, the mice were administered 50 μL saline or dust solution by intratracheal instillation (Control group: 50 μL saline; Test group: 15 mg kg−1 MWCNTs). Mice were injected with these doses once a week for 13 weeks. Then, male and female mice in the same group were allowed to mate to produce offspring. The pups were fed with normal diet until the end of the experiment (12 weeks old). The offspring mice were sacrificed by decapitation to detect the blood biochemistry and the expression of genes and proteins. Results: Compared with the Control group, MWCNTs significantly reduced the weight of offspring mice (male and female) and led to histopathological changes in the liver tissues. The expression of liver fat synthesis gene significantly increased (P < 0.05 or P < 0.01). The expression of genes and proteins involved in the inflammatory reactions appeared to be abnormal (P < 0.05 or P < 0.01). Conclusion: Exposure of adult mice to MWCNTs can affect the expression of fatty acid synthesis genes in the liver tissues of offspring mice, leading to disruption of liver function and accumulation of lipid droplets in the hepatocytes. The imbalance between M1 and M2 liver macrophage phenotypes may be one of the underlying mechanisms of action of MWCNTs leading to disordered fatty acid synthesis in offspring mice. [ABSTRACT FROM AUTHOR]

Background. The aim of this investigation was to compare the sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine combinations on fearful children needing dental treatment. Methods. This crossover double-blind clinical trial was conducted on 30 children aged 2‒6 years, who had at least two similar teeth needing pulp treatment. Standard vital signs were recorded before and after premedication. Wilson sedation scale was used to judge the level of sedation. Cases were divided into two groups based on the sequence of medication received. This was to overcome the sequence effect. Group I received oral midazolam (0.4 mg/kg/chloral hydrate (50 mg/kg) at the first visit while they received midazolam (0.4 mg/kg)/promethazine (5 mg/kg) in their second visit. Group II received the premedication in the opposite sequence. The operator and child were blinded to the medication administered. Sedative efficacy of the two combinations were assessed and judged by two independent pediatric dentists based on the Wilson scale. Data were analyzed with ANOVA and paired t-test. Results. Only 10% of children who received chloral hydrate with midazolam exhibited high improvement in their behavior while 53% showed reasonable positive changes and 12% had no change or even deterioration of behavior. The difference between the effect of the two combination drugs was statistically significant (P<0.05) in favor of the chloral hydrate group. Conclusion. The results showed a significant difference in the sedation level induced between the two groups. Midazolam/chloral hydrate combination more effectively improved the co-operation for dental treatment. [ABSTRACT FROM AUTHOR]

Poly (vinyl butyral co-poly vinyl alcohol co-vinyl acetate) (PVB-co-PVA/PVAC) combined with 4-(p-nitrophenyl-azo)-1-naphthol dye has been examined a promised dosimeter suitable for high dose ranges. The prepared films have yellow color. This color undergoes color bleaching upon irradiation with gamma rays. Different concentrations were prepared to obtain the suitable dosimeter in the dose range from 3 to 200kGy depending on the dye concentration. Chloral hydrate was then added in different concentrations, as a result the bleaching reaction expedites and in accordance the dose range diminishes to be 35kGy. The effect of chloral hydrate as well as dye concentration on response curve was studied. The radiation efficiency (G-value) was estimated for all the prepared films. Influence of relative humidity during irradiation was estimated as well as stability before and after irradiation. [ABSTRACT FROM AUTHOR]

To explore the health effects of multi-heavy metal exposure, Sprague Dawley (SD) rats were orally given one dose of heavy metal mixtures (HMMs). The eight most common detectable heavy metals in Ningbo area are zinc (Zn), copper (Cu), manganese (Mn), chromium (Cr), nickel (Ni), cadmium (Cd), lead (Pb) and mercury (Hg). In this study, mixtures of these eight heavy metals were prepared using the compounds zinc sulfate heptahydrate, cupric sulfate, manganese dichloride, potassium dichromate, nickel dichloride, cadmium dichloride, lead acetate, and methyl mercury chloride with ion mass proportions of 1070.0, 312.6, 173.1, 82.6, 30.0, 13.3, 6.6, and 1.0, respectively. The rats were randomly divided into four groups. Beside the control group, each rat received a corresponding dose of HMMs 215, 464 or 1000 mg per kg body weight (bwt), respectively. The rats were observed for 4 weeks. During the last week of observation, the Morris water maze test was used to investigate spatial learning and memory in the treated rats. The rats were exsanguinated under complete chloral hydrate anesthesia and organ coefficients were measured. Biochemical tests of blood and serum samples were carried out. The results showed abnormalities in the hematological system, decreased renal function, hepatic injury and disturbances in the electrolyte balance of the rats treated with a high dose of HMMs. Death of some rats was also observed. This paper analyzed how a one-time high dose oral administration of HMMs induced systemic toxicity. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that oxymatrine may inhibit ventricular remodeling and serves an important role in the treatment of cardiovascular disease. The present study investigated whether oxymatrine treatment protects against the effects of cardiopulmonary resuscitation (CPR) via regulation of the transforming growth factor‑β1 (TGF‑β1)/mothers against decapentaplegic (Smad) signaling pathway. A CPR model was established in Sprague‑Dawley (SD) rats by asphyxiation, and rats were subsequently anaesthetized by intraperitoneal injection of chloral hydrate. SD rats were then administered 25 or 50 mg/kg oxymatrine once a day for 4 weeks. Oxymatrine treatment significantly improved troponin I levels, the ejection fraction, hydroxyproline content and the myocardial performance index in model rats. However, treatment with oxymatrine significantly reduced arterial oxygen tension, arterial lactate levels and oxygen extraction. Treatment with oxymatrine following CPR significantly inhibited the protein expression levels of TGF‑β1, TGF‑β1 receptor type 1 and Smad homolog 3 (Smad3) in model rats. The results of this research indicated that oxymatrine treatment may protect against the effects of CPR via regulation of the TGF‑β1/Smad3 signaling pathway and may be a novel drug for CPR in a clinical setting. [ABSTRACT FROM AUTHOR]