Comparative Efficacy of Oral Triclofos in Pediatric Neuroimaging and Other Procedural Sedation: A Systematic Review and Meta-analysis

Sedation is a mandatory part of successfully performing diagnostic and therapeutic? procedures in struggling children or when lying still is a necessity. Many drugs are advocated but there is no consensus on choice of drug , route , dose etc. Practice varies by country, area,? procedure and clinician widely. Oral route is always preferred, for its low cost , safety and non requirement of expert handling by anesthetists. Triclofos is active metabolite of Chloral hydrate sedative anxiolytic. Both lost their ground with inclusion in WHO list of restricted pharmaceuticals in 2010. Unmonitored misuse of drug? was the reasons behind. However Triclofos remained in use in India, and no serious side effects were noted during one time use under medical supervision for procedural sedation in last 20 years. This Systematic review ascertains its safety and efficacy.? Protocol was registered at PROSPERO vide no CRD42021237574. Twenty four? studies with 2337 subjects were included, 18 clinical trials for safety? and efficacy both while 6 observational studies for safety only. Triclofos and oral Midazolam both appeared as preferred drugs for procedural sedation without any statistically significant difference. Triclofos was used in much higher doses in all studies varying? from 2.5 to 5 times higher than recommended dose of 20 mg/kg in Indian books. Preservative free IV midazolam preparation mixed with fruit juice was commonly used orally. No serious side effects were noted for triclofos in any study. We concluded that one time use of triclofos under medical supervision is safe and effective. ?