Methods of sedation for auditory brainstem response testing.

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.