A COMPARISON OF HYPNOTIC AGENTS

¹ The Anesthesia Laboratory of the Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts

1. The hypnotic effects of three agents (chloral hydrate, pentobarbital sodium, and methylparafynol) have been assessed in 268 ward patients on their first night in the hospital following admission for elective surgery. The experimental design employed the principles of placebo controls, "double blind" technique, concurrent comparison, randomization of subjects, and statistical treatment of data.

2. Chloral hydrate, in a dose of 1.0 gm., was satisfactory for the rapid induction of sleep but did not differ from a placebo in providing five hours of uninterrupted sleep. Doubling the dose apparently produced prolongation of effect.

3. Pentobarbital sodium, in a dose of 0.1 gm., appeared somewhat less effective in inducing sleep than 1.0 gm. of chloral hydrate. A dose of 0.2 gm. was satisfactory both in inducing sleep and in maintaining sleep for five or more hours.

4. The hypnotic effects of methylparafynol, in 0.5 and 1.0 gm. doses, were indistinguishable from those of a placebo.

5. The use of pentobarbital sodium was followed by "hangover" in a number of instances, whereas chloral hydrate seemed relatively free of such effect. Neither agent was responsible for severe gastrointestinal disturbances and the incidence of nausea was low.

6. It is suggested that a rational approach to the use of hypnotics requires the accumulation of data in controlled clinical trials such as the one described.

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