Luque Carolina Grau, Atkins-Labelle Cheryl, Pauwels Julie, Costello Rhodri, Kozak Frederick K, Chadha Neil K
University of British Columbia, Vancouver, British Columbia, Canada; Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
Int J Pediatr Otorhinolaryngol. 2021 Dec;151:110945. doi: 10.1016/j.ijporl.2021.110945. Epub 2021 Oct 19.
The auditory brainstem response (ABR) hearing test can be challenging in children with autism spectrum disorder (ASD) due to the inherent behavioral challenges associated with this condition. To attempt to increase our success in sedating ASD patients, we added the use of intranasal Dexmedetomidine (Dexmed) to be used alone or with oral Chloral Hydrate (CH) in an ambulatory care setting, with monitoring by a specialist nurse.
To determine the success and safety of a protocol for ABR testing performed under sedation with intranasal Dexmed and oral chloral hydrate in ASD patients. To compare the success rate, the occurrence of adverse events and time needed to initiate ABR between Dexmed-CH protocol and previous CH-alone protocol in ASD patients.
Retrospective review. ASD patients in Dexmed-CH sedation protocol were age- and sex-matched to ASD patients who underwent CH-alone sedation protocol, for comparison.
74 ABR records in ASD children were included, 37 patients using Dex-CH protocol and 37 patients using CH-alone protocol. In the Dexmed-CH protocol group, Dexmed was used in 2 different ways: alone as a first choice in patients who refused to swallow CH (9/37), or combined with CH as a rescue (28/37). Under this sedation protocol, 89% of the attempted ABRs were completed successfully with no major adverse effects. In comparison, in ASD patients sedated using the protocol of CH-alone, the success rate significantly lower (69% vs. 89%). The time needed to initiate the test was not significantly different.
The use of intranasal Dexmed by itself or in combination with CH was a safe and reliable method of performing sedated ABR in ASD patients. Modifying our previous oral CH protocol to include intranasal Dexmed, substantially improved our success rate of sedation in ASD patients in an ambulatory setting. This study may be of significant value to centers worldwide exploring alternatives to general anesthesia for ABR testing in ASD patients.
由于自闭症谱系障碍（ASD）患儿存在固有的行为挑战，听觉脑干反应（ABR）听力测试对他们来说可能具有挑战性。为了提高我们在为ASD患者实施镇静方面的成功率，我们在门诊护理环境中增加了鼻内使用右美托咪定（Dexmed）单独或与口服水合氯醛（CH）联合使用，并由专科护士进行监测。
确定在ASD患者中使用鼻内右美托咪定和口服水合氯醛进行镇静下ABR测试方案的成功率和安全性。比较ASD患者中右美托咪定-水合氯醛方案与先前单纯水合氯醛方案之间的成功率、不良事件发生率以及开始ABR测试所需的时间。
回顾性研究。将接受右美托咪定-水合氯醛镇静方案的ASD患者与接受单纯水合氯醛镇静方案的ASD患者按年龄和性别进行匹配，以作比较。
纳入了74例ASD儿童的ABR记录，37例患者使用右美托咪定-水合氯醛方案，37例患者使用单纯水合氯醛方案。在右美托咪定-水合氯醛方案组中，右美托咪定有两种不同的使用方式：在拒绝吞咽水合氯醛的患者中作为首选单独使用（9/37），或与水合氯醛联合作为补救措施使用（28/37）。在该镇静方案下，89%的ABR测试尝试成功完成，且无重大不良反应。相比之下，在使用单纯水合氯醛方案镇静的ASD患者中，成功率显著较低（69%对89%）。开始测试所需的时间无显著差异。
单独使用鼻内右美托咪定或与水合氯醛联合使用是在ASD患者中进行镇静ABR测试的一种安全可靠的方法。将我们先前的口服水合氯醛方案修改为包括鼻内右美托咪定，在门诊环境中显著提高了我们在ASD患者中的镇静成功率。这项研究可能对全球范围内探索ASD患者ABR测试替代全身麻醉方法的中心具有重要价值。
