The Efficacy and Safety of Rectal Thiopental Sodium for Sedation of Children in the Emergency Department

Abstract

PURPOSE: This study evaluated rectal administration of thiopental sodium provides an efficient and safe method of sedation for children in the emergency department. METHODS: A prospective, randomized, non-blind study was conducted for 18 months. Thiopental and midazolam were given by rectal administration. Chloral hydrate was given by either oral or rectal administration. Ketamine was given by intramuscular injection. The administration dose of thiopental was 25 mg/kg. We evaluated the induction time, the recovery time, the Ramsay scale, the sedative effects for the procedure and the adverse effects of each drug. RESULTS: Eighty-six (86) children were enrolled in this study. Thiopental was administered to 21 children, ketamine to 21 children, chloral hydrate to 21 children and midazolam to 23 children. The induction time for thiopental, chloral hydrate and ketamine groups were 7.6+/-4.0 min, 36.0+/-7.0 min and 7.4+/-3.8 min, respectively. The recovery time for thiopental, chloral hydrate and ketamine groups were 54.1+/-11.8 min, 76.2+/-11.4 min and 64.8+/-18.2 min, respectively. The differences in the induction time and the recovery time for each group are statistically significant (p<0.001). The Ramsay scale for thiopental, chloral hydrate, ketamine and midazolam groups were 5.4+/-1.0, 5.7+/-0.5, 6.0+/-0.2 and 1.7+/-0.7, respectively. In thiopental group, one child (4.7%) experienced desaturation and one child (4.7%) experienced a decrease in blood pressure, but, no child required hospitalization for any complication from these sedatives. CONCLUSION: Rectal administration of thiopental is efficacious and safe for sedation of pediatric patients in the Emergency Department.