Chloral hydrate outperforms oral midazolam in facilitating venipuncture in children: A double-blind randomized trial.
Ali Khakshour, Javad Akhondian, Amin Saeidinia et al.
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In 30 seconds
This prospective, double-blind randomized trial compared oral chloral hydrate with oral midazolam for facilitating venipuncture in hospitalized children aged 1–5 years in a tertiary hospital emergency department. Among 100 children, chloral hydrate was associated with fewer attempts for successful venipuncture: 1.30 versus 1.96 (mean difference −0.66, 95% CI −0.92 to −0.40; p < 0.001). Sedation, IV access, and total procedural times were also shorter, while recovery time and safety outcomes were comparable. Parent and nurse satisfaction was higher with chloral hydrate.
Key findings
- Successful venipuncture required 1.30 attempts with chloral hydrate versus 1.96 with midazolam (mean difference −0.66, 95% CI −0.92 to −0.40; p < 0.001).
- Time to adequate sedation, IV access time, and total procedural time were shorter with chloral hydrate (all p < 0.001).
- Recovery time did not differ (p = 0.819); vital signs remained stable and minor adverse events were low and similar between groups.
- Parent and nurse satisfaction was significantly higher with chloral hydrate.
Why it matters
Venipuncture can be distressing and difficult in young children, and repeated attempts add to procedural burden. This randomized comparison suggests chloral hydrate may facilitate more efficient venipuncture than oral midazolam in the studied emergency and trauma setting, without an observed difference in recovery time or safety outcomes. These results provide comparative evidence for a common procedural sedation decision.
What to keep in mind
The trial was conducted at a single tertiary hospital emergency department, limiting certainty about applicability to other settings and populations.