Lakhasly

NTRODUCTION

Paediatric ophthalmologists are commonly faced with an uncooperative child who needs to undergo a diagnostic procedure as simple as funduscopy or slightly more invasive, such as intraocular pressure (IOP) measurement or gonioscopy.Concerns have been raised about severe adverse events (AE) related to its use, mainly as a result of overdosage and in some countries (eg, the USA) it is not included in the list of approved drugs.Alternatives to examination under general anaesthesia (EUA) are highly sought after, since an EUA is costly, relies on the availability of staff and time in the operating theatre, and also carries a non-negligible risk of damage to the child's development that has been k increasingly recognized in recent years.1

Chloral hydrate (CH) is an old drug that has been used for procedural sedation in children, espe-cially for diagnostic imaging.

NTRODUCTION

Paediatric ophthalmologists are commonly faced with an uncooperative child who needs to undergo a diagnostic procedure as simple as funduscopy or slightly more invasive, such as intraocular pressure (IOP) measurement or gonioscopy. Alternatives to examination under general anaesthesia (EUA) are highly sought after, since an EUA is costly, relies on the availability of staff and time in the operating theatre, and also carries a non-negligible risk of damage to the child's development that has been k increasingly recognized in recent years.¹

Chloral hydrate (CH) is an old drug that has been used for procedural sedation in children, espe-cially for diagnostic imaging. Concerns have been raised about severe adverse events (AE) related to its use, mainly as a result of overdosage and in some countries (eg, the USA) it is not included in the list of approved drugs. However, recent studies reveal that some paediatric ophthalmology units use it routinely in hospital-based outpatient nurse-led clinics and report large series with no severe side effects.3 4 This approach has actually been shown to be cost-saving in a cross-over study comparing CH to EUA, without posing morbidity or mortality risks. In 2010, the UK National 5 Institute for Health and Care Excellence (NICE) guidelines for sedation in children and young people proposed its use as an option for children under 15 kg undergoing a painless procedure such as diagnostic imaging.

However, some suggest the use of CH for pro-cedural sedation in children and some suggest its avoidance. Given the different approaches, this study aims to review the efficacy of CH in achie-ving paediatric ophthalmic examinations under sed-ation, as well as the drug's safety, according to literature reports of the side effects of its use in children.