Sedation for Pediatric Echocardiography in Congenital Heart Disease: Dexmedetomidine versus Chloral Hydrate
DOI:
https://doi.org/10.56260/sciena.v5i5.390Keywords:
chloral hydrate, child, Conscious Sedation, Dexmedetomidine, Echocardiography, Heart Defects, CongenitalAbstract
Background: Chloral hydrate is commonly used for paediatric transthoracic echocardiography (TTE) sedation, but safety concerns have prompted interest in alternatives. This meta-analysis compared intranasal dexmedetomidine with oral chloral hydrate for TTE sedation in children with known or suspected congenital heart disease (CHD). Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and was registered in PROSPERO [CRD420261376912]. PubMed/MEDLINE, Europe PMC, Cochrane CENTRAL, and ClinicalTrials.gov were searched to 30 September 2026. Risk of bias was assessed with Cochrane tools and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using random-effects models, with Hartung–Knapp adjustment when ≥3 studies contributed. Results: Four studies (one randomised trial and three cohort studies; 1414 children, 1187 in the primary analysis) were included. Single-dose sedation success did not differ in the randomised trial (risk ratio [RR] 1.02; 95% confidence interval [CI] 0.96–1.09), in the pooled non-randomised studies (RR 1.11; 95% CI 0.71–1.73), or overall (RR 1.08; 95% CI 0.85–1.36; very low certainty). Onset time and hypoxia did not differ significantly (very low certainty); rescue dose requirement was not pooled because its definition was not comparable across studies. Recovery time was shorter with dexmedetomidine (mean difference −9.96 min; 95% CI −18.71 to −1.22; low certainty). Bradycardia was more frequent with dexmedetomidine (RR 2.32; 95% CI 1.09–4.95; very low certainty), although no study reported its treatment. Conclusion: In children with known or suspected CHD, the two agents showed no clear difference in TTE sedation success, whereas bradycardia was more frequent with dexmedetomidine. Given low-to-very-low certainty of evidence, neither agent can be considered superior; adequately powered randomised trials are needed.
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Copyright (c) 2026 Jane Elvina Sentosa, Anas Alatas , Aries Perdana, Komang Ayu Ferdiana, Aldy Heriwardito , Jefferson Hidayat, Ratna Farida Soenarto, Andy Omega, Azhraa Qinan Pranaya
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