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Question 1 Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging?
  1. Michelle Hare
  1. Correspondence to Michelle Hare, Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire, S10 2TH, United Kingdom; michellehare{at}doctors.org.uk

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Scenario

A 2-year-old child is acutely admitted at night to a district general hospital following a prolonged focal seizure. A CT scan of the head without sedation fails as the child is too active and distressed, and as the on-call paediatric registrar, you are requested by the radiographer to prescribe a sedative. The NICE guideline for sedation in children and young people advises that midazolam or chloral hydrate can be used to sedate for painless procedures.1 You wonder which of these drugs is the most effective and safe and which has the least side effects.

Structured clinical question

In children who require sedation for painless diagnostic imaging [population], is chloral hydrate [intervention] better than midazolam [comparison] in achieving effective and safe sedation [outcome]?

Search strategy and outcome

Medline (1948 to March week 5 2011) and Embase (1947 to 8 April 2011) were searched via Ovid on 11 April 2011 using the search terms ((chloral adj2 hydrate) AND midazolam) AND ((imaging or neuroimaging) OR ultrasound OR ultrasonog* OR scan* OR (computed ajd2 tomography) OR CT OR (magnetic adj2 resonance adj2 imaging) OR MRI OR echocardio* OR (painless adj2 procedure)). A total of 151 abstracts were reviewed and seven relevant articles were found (table 1). The citations in these articles and the Cochrane Library yielded no further …

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