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Sedation for diagnostic Echocardiograms

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This protocol only applies provided the criteria outlined in the Starship Sedation Policy are adhered to and doses are administered under strict medical supervision.

Only to be used in the paediatric cardiology ward or clinic when a paediatric cardiologist is easily accessible. For children coming from other services or wards, sedation for echocardiograms must be administered in the cardiology department and children should not be transferred until the effects of sedation have waned.

Indications

Motion control and amnesia for diagnostic echocardiograms only (use alternate sedation for other procedures).

N.B. For infants <3 months of age an echocardiogram is usually attempted without sedation or using sucrose only in the first instance and sedation is only used if this is unsuccessful. (See Sucrose Analgesia for Simple Neonatal Procedures).

Dosage

  Drug Dose Onset Duration
Infant < 4 kg Chloral Hydrate PO
Biomed 200mg/ml Formulation (preservative free) **
50mg/kg# 20 min 60-90 min
Child 4-10kg Chloral Hydrate PO
Biomed 200mg/ml Formulation (preservative free) **
100mg/kg#
(max dose 1000mg)
20 min 60-90 min
Child >10kg Midazolam PO
Oral Liquid 2mg/ml formulation***
0.5mg/kg ##
(max 15mg)
30 min 1-2 hours


** Other formulations of Chloral Hydrate are available (e.g. 100mg/ml), however these are subject to Section 29 registration
***Midazolam liquid is a Section 29 medication

Monitoring/observations

For guidelines on monitoring sedated children, refer to the Starship Sedation Policy.

Caution/contraindications

For full list of contraindications see Starship Sedation Policy

Deep Sedation should not be used in the following circumstances without expert assistance and consideration of dose adjustment ( e.g. Chloral hydrate 50mg/kg).

  • Neonates (<4 weeks) or Ex Prem infants less than 60 weeks post conceptual age.
  • Children with syndromes (Trisomy 21 etc)
  • Children with compromised respiratory function (including an intercurrent URTI).
  • Airway abnormalities which may cause obstruction (patients with stridor, craniofacial abnormalities, sleep apnoea).
  • Neurologically impaired.
  • Severe obesity.

Documentation and clinical forms

  • Consent form signed
  • Sedation record (CR8762) completed as appropriate including the prescription of sedative agent (s) to be used

Dose References

# Chloral Hydrate dose from New Zealand Formulary for Children
##Midazolam Dose from New Zealand Formulary for Children

NB: For procedures other than diagnostic echocardiograms, alternative dosage regimens for Chloral Hydrate should be used

Associated documents

Sedation in Children Starship Sedation Policy
Fasting Prior to General Anaesthesia for Elective Surgery and/or Procedures - Paed (ADHB only) (copy and paste this link into ADHB browser \\ahsl6.adhb.govt.nz\main\Groups\Everyone\POLICY\Master file of Intranet\Clinical Practice\Board\FastingAnaesthesiaParenteral.pdf)
Informed Consent (ADHB only) (copy and paste this link into ADHB browser - \\ahsl6.adhb.govt.nz\main\Groups\Everyone\POLICY\Master file of Intranet\Board\PCR\InformedConsent.pdf)
Resuscitation of Children (Paediatric Code Blue)

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Document Control

  • Date last published: 20 May 2013
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Owner: J Key
  • Editor: Marion Hamer
  • Review frequency: 2 years