Abstract
Background: Intranasal dexmedetomidine (IN DEX) is a relatively new sedative agent with supporting evidence on its efficacy and safety, which can be used for procedural sedation in children, and could have a major role in auditory brainstem response testing, especially in the case of non-cooperative children. The goal of this systematic review is to assess the role of IN DEX in ABR testing, evaluating the reported protocol, potential, and limits. Methods: We performed a comprehensive search strategy on PubMed, Scopus, and Google Scholar, including studies in English on the pediatric population, without time restrictions. Results: Six articles, published between 2016 and 2021, were included in the systematic review. Sedation effectiveness was high across the studies, except for one study; 3 μg/kg was the dosing most often used. A comparison group was present in three studies, with oral chloral hydrate as the drug of comparison. Adverse effects were rarely reported. Conclusion: This systematic review showed how IN DEX can represent an adequate sedative for children undergoing ABR testing; larger and more rigorous trials are warranted in order to recommend its systematic utilization.
Highlights
Auditory brainstem response (ABR) is a crucial screening test for hearing loss in children, representing the gold standard for objective hearing evaluation in infants and toddlers [1]
Seven articles were excluded (n = 2, studies conducted on animals; n = 3 high risk of bias due to different outcomes; n = 1, no full-text available; and n = 1, Intranasal dexmedetomidine (IN DEX) in association with another type of sedative) and the remaining six were included in the systematic review
IN DEX has an established role in procedural sedation for the pediatric population, including ABR testing, the number of studies focusing on its use exclusively for ABR is still limited
Summary
Auditory brainstem response (ABR) is a crucial screening test for hearing loss in children, representing the gold standard for objective hearing evaluation in infants and toddlers [1]. ABR testing require in children the administration of a safe and stable sedative drug to avoid artifacts; babies cannot be calm enough to allow the test or unable to sleep, while children cannot be cooperative as in case of subjects with behavioural or developmental disabilities [2]. Traditional sedatives, like chloral hydrate, benzodiazepines, and barbiturates, could pose some risks, like vomiting, respiratory depression, and even death [3,5]. With the discontinuation in the production of chloral hydrate in several countries [6], midazolam appears to currently be the most used sedative in the pediatric population [7], but other safer options are emerging [8].
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