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Methods of sedation for auditory brainstem response testing
1Division of Otolaryngology, Children's Hospital of Alabama, University of Alabama at Birmingham 35233, USA.
Insights
Sedation for auditory brainstem response (ABR) testing in children lacks standardized methods. A study found 50 mg/kg chloral hydrate is safe and effective in an outpatient setting, proving more cost-effective than operating room procedures.
Area of Science:
- Pediatric Audiology
- Neuroscience
- Clinical Pharmacology
Background:
- Sedation is often necessary for auditory brainstem response (ABR) testing in young children and individuals with cognitive impairments.
- Current practices for sedation during ABR testing lack standardization regarding pharmacotherapy, monitoring, facilities, and personnel.
- There is a need to establish safe, effective, and cost-efficient sedation protocols for ABR testing.
Purpose of the Study:
- To survey current national practices for sedation during ABR testing in children's hospitals.
- To prospectively evaluate the safety and efficacy of oral chloral hydrate for ABR sedation.
- To compare the cost-effectiveness of performing ABR testing in outpatient settings versus the operating room.
Main Methods:
- A national survey was distributed to 149 free-standing children's hospitals in the US.
- A prospective study administered 50 mg/kg oral chloral hydrate for sedation in an outpatient ABR testing setting.
- Continuous monitoring of vital signs, skin color, and oxygen saturation was performed during sedation.
Main Results:
- Survey results revealed significant variability in sedation administration and reported complications across institutions.
- The administration of 50 mg/kg chloral hydrate in an outpatient setting was found to be safe and effective.
- Performing ABR testing in a monitored outpatient suite is more cost-effective than conducting it in an operating room.
Conclusions:
- Standardized sedation protocols are needed for pediatric ABR testing.
- Oral chloral hydrate at 50 mg/kg is a safe and effective option for sedating children for ABR testing.
- Outpatient ABR testing with sedation offers a more cost-effective alternative to operating room procedures.
Abstract:
Young children and those who are mentally impaired frequently require sedation to attain accurate results when testing for auditory brainstem response (ABR). There have been no previous studies of appropriate methods of sedation, and there is no consensus on pharmacotherapy, monitoring equipment, facilities, or personnel necessary for safe and effective ABR testing. To obtain a national census of current practice, we sent a survey to 149 free-standing children's hospitals in the US. A prospective study was also conducted to assess the effects of sedation utilized to perform ABR testing at The Children's Hospital of Alabama. Oral chloral hydrate (50 mg/kg) was administered for sedation in an outpatient setting with a registered nurse and audiologist present, while vital signs, skin color, and oxygen saturation were continuously monitored. The cost of testing in an audiology or other outpatient suite was compared with the cost of performing the study in the operating room. Results of the survey illustrated the present lack of national uniformity in sedation administered, as well as various problems and complications encountered with such testing. We found that 50 mg/kg chloral hydrate administered in this setting is safe and effective for children requiring sedation for audiologic testing. Further, the ability to perform ABR's in an outpatient suite in a monitored setting is more cost-effective than testing in the operating room.