The Safety of Nurse Led Sedation Service for Auditory Brain Response Testing

Background: There are growing numbers of pediatric procedures requiring sedation outside the operating room. Among them is recording of Auditory Brainstem Response (ABR). In recent years, our department of anesthesiology established nurse led pediatric sedation service. A sedation protocol based on Chloral Hydrate (CH) was established and approved, and experienced pediatric critical care nurses have been trained accordingly.

Objective: To retrospectively analyze our experience with nurse led sedation using CH in children undergoing ABR.

Methods: Data of pediatric patients undergoing sedation for ABR recordings between January 2014 and December 2016 was retrieved from their medical and sedation charts. Specifically the following measurements were analyzed: Age, Sedation induction time, Sleep duration and adverse reactions.

Results: 849 children, ASA score 1- 2, 1.2±1.3 (mean±SD) years old were included. Main indications for ABR were: prematurity (N=139), language delay (N=124), family hearing impairment (N=136) and hearinh loss (N=109). All children were given 60-75 mg / kg CH orally or rectally; time to sleep induction was 28.9±18 minutes and sleep duration was 104±63 minutes. In 835 (98.4%) children, sedation was uneventful and ABR recordings successfully performed. Failure to sedate by Chloral Hydrate occurred in 12 cases (1.4%). Adverse events occurred in 2 patients- one had fever few hours after the procedure and one needed admission for extended monitoring due to adenoids hypertrophy.

Conclusions: Chloral hydrate administered by sedation nurse in this setting is safe and effective for ASA 1 and 2 children requiring sedation for audiologist testing.