Impact of Anesthesia Strategy on Infant Pulmonary Function Test Quality and Duration.

Area of Science:

• Pediatric Pulmonology
• Anesthesiology
• Pharmacology

Background:

• Chloral hydrate (CH) is the standard sedative for infant pulmonary function testing (iPFT).
• Current CH shortages necessitate exploring alternative sedation strategies for iPFT.
• Evaluating the safety, duration, and quality of these alternatives is crucial.

Purpose of the Study:

• To compare the safety, test duration, and test quality of alternative sedation strategies for iPFT.
• To assess ketamine/midazolam (KM), dexmedetomidine (DX), and polypharmacy (PP) against CH.

Main Methods:

• Retrospective chart review of 66 pediatric iPFTs (2019-2021).
• Data abstracted included demographics, sedation agents, adverse events, iPFT type, duration, and quality.
• Bivariate and multivariable analyses compared CH to KM, DX, and PP.

Main Results:

• No significant differences in iPFT types or satisfactory test proportions between CH and alternatives.
• Shorter procedure time with KM, shorter induction time with DX; longer recovery time with DX.
• Total testing time was longer with PP (12.0 min increase) vs. CH; no difference for KM or DX.
• Mild adverse events occurred in 3 patients (2 PP, 1 DX).

Conclusions:

• Ketamine/midazolam (KM), dexmedetomidine (DX), and polypharmacy (PP) appear to be safe and effective alternatives to CH for iPFT sedation.
• These agents offer viable options amidst CH shortages, with comparable test quality.
• Further research may refine optimal use of these alternative sedatives.