Effect of Chloral Hydrate Sedation on Intraocular Pressure in a Pediatric Population

Purpose: To determine the effect of oral chloral hydrate (CH) sedation on intraocular pressure (IOP) in an outpatient pediatric population. Design: Prospective, noncomparative case series. Methods: Children aged 1 month to 5 years undergoing CH sedation for ocular imaging/evaluation at a tertiary eye hospital were included. IOP was measured using an Icare tonometer prior to sedation (in some, not all), at 25 minutes after sedation, and then every 10 minutes until sedation completion. Change in IOP over time was assessed using mixed model linear regression to account for correlation of IOP readings. Results: A total of 112 children were enrolled, 50.9% were female, and mean age was 2.1 (standard deviation [SD]: 1.3) years. Of the total, 83 (74.1%) participants had IOP measurement attempted prior to sedation, with 64 having presedation IOP completed. Among those completing presedation IOP, 46.9% were asleep/calm, and the rest (53.1%) were slightly/more distressed (IOP did not differ by level of agitation). Those with and without presedation IOP available had similar demographics and health status (P >.05). Heart rate, respiratory rate, and oxygen saturation all declined after sedation (P <.001). The mean dose of CH administered was 80.9 (SD: 13.2) mg/kg, and sedation was deemed “adequate” in 97.3% after a single dose. Mean IOP among those with presedation IOP was 19.5 mm Hg and, although not significant, declined to 18.7 mm Hg at 25 minutes (P =.12). There was no trend toward further decline in IOP over time (P >.05). Conclusions: CH sedation for outpatient pediatric ophthalmic procedures as administered in this prospective assessment had no impact on IOP.