Triclofos for Sedation: Clinical Recommendations
Triclofos sodium is a chloral derivative sedative that can be safely and effectively used for pediatric sedation in non-painful diagnostic procedures at a dose of 75-80 mg/kg orally, with onset typically within 25-45 minutes, though it should not be used for anxiolysis or pain management. 1, 2
Primary Indications and Dosing
Triclofos is appropriate for:
- Non-painful neurodiagnostic studies including EEG and audiometry in children 1
- Ophthalmic examinations in pediatric glaucoma patients 2
- Pediatric dental procedures when combined with nitrous oxide 3
Standard dosing: 75-80 mg/kg orally, administered 45 minutes before the procedure 3, 1, 2. If inadequate sedation occurs after 30 minutes, additional doses of 5 mg/kg can be given every 5 minutes up to 60 minutes total 2.
Safety Profile in Pediatric Populations
Triclofos demonstrates excellent safety even in high-risk populations:
- Success rate of 88.5% for achieving adequate sedation depth 1
- Minimal adverse events: desaturation ≤90% in only 0.2% of patients, emesis in 0.35%, and zero cases of apnea or hemodynamic instability 1
- Safe in neurocognitively impaired children including those with seizures, hypotonia, or developmental delay 1
The median onset time is 25-45 minutes with a median duration of 35 minutes 1, 2.
Critical Limitations and Contraindications
Triclofos is NOT appropriate for:
- Anxiolysis or anxiety management - benzodiazepines are more effective for this indication, though they carry significant risks 4
- Pain management - it lacks analgesic properties and should not be used for painful procedures 4
- Adult sedation - evidence is limited to pediatric populations 1, 2
Comparative Effectiveness
When compared to other pediatric sedatives:
- Midazolam is superior for producing conscious sedation in dental procedures 5
- Triclofos ranks second after midazolam but before tramadol for sedation quality 5
- Combination therapy with promethazine (50 mg/kg triclofos + 1 mg/kg promethazine) improves behavioral management in extremely apprehensive children 3
Monitoring Requirements
During triclofos sedation, continuous monitoring must include:
- Heart rate and oxygen saturation throughout the sedation period 1, 2
- Ramsay sedation score measured every 5 minutes starting 20 minutes post-administration 2
- Controlled and monitored environment is mandatory for safe administration 1
Clinical Pitfalls to Avoid
Rare but documented adverse effect: Non-epileptic pedaling-like movements with upper eye deviations can occur 15 minutes post-administration, lasting up to 2 hours intermittently 6. This movement is not epileptic in nature and can be arrested by manual restraint 6.
Failure threshold: If Ramsay sedation score remains ≤4 after 60 minutes of initial drug administration, the procedure should be considered a failure and general anesthesia should be administered 2.
Physical restraint may still be necessary: Even with adequate sedation, extremely apprehensive children may require papoose board restraint for successful procedure completion 3.