Original Research

Comparison of Efficacy of Chloral Hydrate and Midazolam as Sedative in Diagnostic Neuro-Imaging of Children

Haroon Shahid1
Akhtar Saeed Medical and Dental College, Lahore
Faiza Jabeen2
Tehsil Head Quarter Hospital Pattoki
Muhammad Kashif Imran1
Akhtar Saeed Medical and Dental College, Lahore
Saba Bakhat1
Akhtar Saeed Medical and Dental College, Lahore
Khalid Mehmoood Awan1
Akhtar Saeed Medical and Dental College, Lahore
Muhammad Fahad Ali Khan1
Akhtar Saeed Medical and Dental College, Lahore

✉ Correspondence: Haroon Shahid Email: haroonshahid.10@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i3.2647
Volume: 7, Issue 3 Pages: 252–256 Published: 21 Aug 2026
Received: 27 Mar 2026 Revised: 22 Jun 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

Abstract

Objectives

To compare the efficacy of chloral hydrate and midazolam as sedative in diagnostic neuro-imaging of children.

Methods

This Randomized Controlled study was carried out for duration of six months from 23-05-2023 to 23-11-2023 at the Department of Pediatrics, PGMI/ Sheikh Zayed Hospital Lahore. Total 60 patients (30 in each group) from inpatient department of pediatrics Medicine, PGMI/ Sheikh Zayed Hospital, Lahore, were included in the study after fulfilling inclusion criteria. Lottery method was used to divide all patients randomly .Group A: chloral hydrate as oral suspension (50mg/kg) and group B: injectable midazolam (1mg/kg). Ramsay sedation scale was noted for assessment of sedation level.

Results

A total of 60 (30 in each group) patients were included. Mean age was calculated as 7.96 ± 3.20 years in group A(42.9% (n=18) females while 66.7% (n=12) were male and 9.66 ± 2.4 years in group B (57.1% (n=57.1) were females while 33.3% (n=6) were male).This study showed a significant difference in both groups. Efficacy in group A was 73.7% (n=28) and 26.3% (n=10) in group B with a p-value of 0.001.

Conclusion

Chloral hydrate is more effective compared to midazolam as a sedative in diagnostic neuroimaging of children.

Keywords
Midazolam chloral hydrate hypnotics and sedatives conscious sedation sedatives.

How to Cite This Article

Shahid H, Jabeen F, Imran MK, Bakhat S, Awan KM, Khan MFA. Comparison of Efficacy of Chloral Hydrate and Midazolam as Sedative in Diagnostic Neuro-Imaging of Children. J Pak Soc Intern Med. 2026;7(3):252–256. doi:10.70302/jpsim.v7i3.2647

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

References

  1. Verma N, Dahake JS. Evaluating sedation strategies for magnetic resonance imaging: a comprehensive review of intravenous fentanyl, butorphanol, and midazolam in adult and pediatric populations. Cureus. 2024;16(4): e58593.
  2. Leroy PL, Stuart GM. Pediatric sedation: The European experience and approach. InPediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration Cham: Springer International Publishing. 2021;pp. 561-86.
  3. Ferahtia A. Surface water quality assessment in semi-arid region (el hodna watershed, algeria) based on water quality index (wqi). Université de M’sila. 2021. DOI:10.24193/subbchem.2021.1.10 doi:10.24193/subbchem.2021.1.10
  4. Kumar AA, Kesavadas C. Potential of MRI in Clinical Medicine. InMultimodal Biomedical Imaging Techniques 2025 Mar 9 (pp. 271-301). Singapore: Springer Nature Singapore.2025; DOI: https://doi.org/10.1007/978-981-97-3185-4_11 doi:10.1007/978-981-97-3185-4_11
  5. Sophian C. A developmental perspective on children's counting. InThe development of mathematical skills. Psychology Press. 2022;pp. 26-46.
  6. França LG, Ciarrusta J, Gale-Grant O, Fenn-Moltu S, Fitzgibbon S, Chew A, et al. Neonatal brain dynamic functional connectivity in term and preterm infants and its association with early childhood neurodevelopment. Nat Commun. 2024;15(1):16.
  7. Alomar SA, Alshammari AN, Alnajim F, Albesair MA, Esmail A, BinHasan A, et al. Evaluating the Efficacy of Oral Chloral Hydrate and Determinants of Median Induction Time for Pediatric MRI Procedural Sedation: A Time-to-Event Analysis Perspective. DOI: 10.20944/preprints202409. 1352.v1 doi:10.20944/preprints202409
  8. Callahan MJ, Cravero JP. Should I irradiate with computed tomography or sedate for magnetic resonance imaging? Pediatr Radiol. 2022;52(2):340-4.
  9. Green SM, Roback MG, Krauss BS, Miner JR, Schneider S, Kivela PD, et al. Unscheduled procedural sedation: a multidisciplinary consensus practice guideline. Ann Emerg Med. 2019;73(5): e51-65.
  10. Gao F, Wu Y. Procedural sedation in pediatric dentistry: a narrative review. Front Med. 2023; Doi: https://doi.org/10.3389/fmed.2023.1186823 doi:10.3389/fmed.2023.1186823
  11. D’Agostino JA, Terndrup TE. Chloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial. Pediatric emergency care. 2000;16(1):1-4.
  12. Liu H, Zhang X, Yao X, Jin Y, Liu M, Meng Z. Efficacy and safety of chloral hydrate in auditory brainstem response test: a systematic review and single-arm meta-analysis. Clin Otolaryngol. 2024;49(2):161-75.
  13. Fong CY, Lim WK, Li L, Lai NM. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. Cochrane Database Syst Rev. 2021;(8):CD011786.
  14. Siripermpool C, Pattrakornkul N, Thongsattra T, Jianbunjongkit N. Efficacy of rectal versus oral chloral hydrate in pediatric auditory brainstem response: randomized controlled trial. OTO Open. 2024;8(4): e70023.
  15. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633-44.
  16. Riva A, Lapadre G, Grasso EA, Balagura G, Striano P, Verrotti A. Intramuscular midazolam for treatment of status epilepticus. Expert Opin Pharmacother. 2021;22(1):37-44.
  17. Yousuf A, Wani SU, Mir SA, et al. Comparative study of thiopentone and propofol for induction of anesthesia in adult population: a randomized clinical trial. Perioper Care Oper Room Manag. 2025;doi: 10.1016/j.pcorm.2025.100513 doi:10.1016/j.pcorm.2025.100513
  18. Taylor JS, Chandler JM, Menendez M, Diyaolu M, Austin JR, Gibson ML, et al. Small surgeries, big smiles: using virtual reality to reduce the need for sedation or general anesthesia during minor surgical procedures. Pediatric Surge Int. 2021;37(10):1437-45.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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