Pediatric imaging and Sedation (Pedicloryl)

Teaching points by Dr MGK Murthy

• Pedicloryl has now become omnipresent in all Radiology departments for sedating  children. Chemical in the pedicloryl is Triclofos (500mg/5 ml) . Other trade names Tricloryl or Triclotross or silence etc
• It is phosphorylated derivative of chloral hydrate(ethanol derivative). Dosage is 25-30 mg/kg(for up to 1 year) and 250 to 500mg(for1-5 years age) & 500mg-1000mg(6-12 years). Not more than 70-120 mg/kg is to be administered at any time 
• Triclofos gets broken to trichlorethanaol in the body which reduces the time taken to fall asleep by acting on brain. False positivity in urine sugar  can occur 
• American Academy of paediatric committee of drugs(AAPCD)  recommends  the following for avoiding aspiration risk in General before any  diagnostic procedure  (a) Clear liquids up to 2 hours before procedure for any age   (b) Semisolids(including Breast milk)/Solids up to 4 hours for children  6 months age (c) up to 8 hours before the procedure for children older than 36 months 
• Bowel obstruction or Ileus if suspected  increases risk of aspiration and nasogastric suction may help
• Oral contrast in children Abdominal CT scans is controversial . Ideal is to avoid it. Exact incidence of aspiration in diagnostic imaging is not known , however some reports indicate approximately 4% in CT examinations 
• Years of experience/ ease of administration/excellent safety  record(well tolerated) makes pedicloryl ideal for imaging of children  particularly below 2 years of age
• Other challenges of paediatric imaging include (a) decreasing heat loss to prevent hypothermia (Maintain Room Temp 27 deg) (b) Immobilization (with sandbags or adhesive tapes below 6 months age) (c)  Before sedating with Pedicloryl ,by trying (i) After Feeding and (ii)sleep deprivation Techniques for children below 6 months age