Retrospective Comparison of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response Exams

Reynolds, Jason; Rogers, Amber; Capehart, Samantha; Manyang, Peter; Watcha, Mehernoor F.

doi:10.1542/hpeds.2015-0152

Cited by 31 publications

(34 citation statements)

References 27 publications

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“…In our center, a full ABR tests are performed to obtain full profile of latency-intensity function and the intensity used is 90-100 decibels, whereas 60 decibels maybe used in a threshold search as screening test. Although previous studies reported success rate of close to 90% with intranasal dexmedetomidine alone for ABR test, 8,9 in our center the success rate of intranasal dexmedetomidine alone is much lower than 90% when we used ABR test for a full latency-intensity profile. The success rate of intranasal dexmedetomidine as sole agent for ABR test in a retrospective review of our sedation record was 18 out 34 (52.9%); therefore, buccal midazolam is added to intranasal dexmedetomidine for more prolonged or stimulating procedures including ABR test.…”

Section: Introductioncontrasting

confidence: 60%

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A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Yuen

Zhou

et al. 2018

Pediatric Anesthesia

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Summary Background Moderate to deep sedation is required for an auditory brainstem response test when high‐intensity stimulation is used. Chloral hydrate is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric non‐painful procedural sedations. Objective The aim of this study was to compare the sedation success rate after oral chloral hydrate at 50 mg kg−1 and intranasal dexmedetomidine at 3 μg kg−1 plus buccal midazolam at 0.1 mg kg−1 for an auditory brainstem response test. Methods Children who required an auditory brainstem response test were recruited and randomly assigned to receive oral chloral hydrate at 50 mg kg−1 and intranasal placebo, or intranasal dexmedetomidine at 3 μg kg−1 with buccal midazolam 0.1 mg kg−1. The primary outcome was the rate of successful sedation for auditory brainstem response tests. Results Fifty‐seven out of 82 (69.5%) were successfully sedated after chloral hydrate, while 70 out of 78 (89.7%) children were successfully sedated with dexmedetomidine plus midazolam combination, with the odd ratio (95% CI) for successful sedation between dexmedetomidine plus midazolam combination and chloral hydrate estimated to be 3.84 (1.61‐9.16), P = 0.002. Dexmedetomidine plus midazolam was associated with quicker onset with median onset time 15 (IQR 11.0‐19.8) for dexmedetomidine plus midazolam and 20 (IQR 15.0‐27.0) for chloral hydrate respectively, with difference between median (95% CI) of 5 [3‐8], P < 0.0001). The behavior observed during drug administration of intranasal dexmedetomidine and buccal midazolam was better that of the children who had oral chloral hydrate. No children required oxygen therapy or medical intervention for hemodynamic disturbances in this study and the incidence of hypotension and bradycardia was similar. Conclusion Intranasal dexmedetomidine plus buccal midazolam was associated with higher sedation success with deeper level of sedation, with similar discharge time and adverse event rate when compared to chloral hydrate.

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Section: Introductioncontrasting

confidence: 60%

“…It was revealed in previous report that intranasal dexmedetomidine alone is adequate to achieve satisfactory sedation for ABR test . But when the intensity of ABR test is high to obtain a full latency‐intensity profile, additional or rescue sedative would be required.…”

Section: Discussionmentioning

confidence: 97%

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Yuen

Zhou

et al. 2018

Pediatric Anesthesia

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“…The study was designed to detect a difference that would permit reliable completion of an additional case to justify the increased costs of dexmedetomidine. The study may have been underpowered to detect smaller differences in testing times and a recent retrospective study did demonstrate such a difference . Another possible explanation is that the audiologist may continue to test the patient as long as the child is sedated and stops when the effects of sedation wear off and the child begins to move.…”

Section: Discussionmentioning

confidence: 98%

“…The sample size was based on a two group comparison of means, assuming that: (i) the mean ± sd time for study completion would be similar to that in an IRB approved retrospective study (108 ± 31 min) ; (ii) A reduction in mean time of 20 min would be of clinical relevance as it would permit one additional case to be reliably completed in a 10 h shift; (iii) Standard deviation in both groups would be the same as in the retrospective study (31 min); (iv) Power = 80% at the 0.05 level of significance. Based on these assumptions, a group size of 39 was calculated.…”

Section: Methodsmentioning

confidence: 99%

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A prospective, randomized, double‐blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing

Reynolds

Rogers

Medellin

et al. 2016

Pediatric Anesthesia

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Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial

et al. 2023

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The purpose of this study was to compare the efficacy of oral triclofos (TRI), intranasal midazolam (INM), and intranasal dexmedetomidine (IND) in achieving successful sedation in children undergoing MRI. This open-label, three-arm, randomized trial was conducted in a tertiary care teaching hospital over 18-month period. Children scheduled for MRI were enrolled. Rate of successful/adequate sedation was assessed using the Paediatric Sedation State Scale (PSSS). The primary outcome was the efficacy (successful sedation or sedation rate) of the three drugs. One-hundred and ninety-five children were included for the MRI procedure. IND was found to be superior in terms of achieving successful sedation. INM had a shorter onset and duration of sedation compared to IND and TRI, but with an increased failure rate (88.3%). Keeping INM as the reference group, it was found that the odds of sedation increased 4.1 times on changing from INM to IND (p < 0.01), and 2.26 times on changing from INM to TRI (p < 0.01). Adverse events included nasal discomfort (18.3%) in INM group; and self-limited tachycardia (4.6%) and hypotension (10.8%) in the IND group.Conclusion: IND was more efficacious than INM or TRI for procedural sedation in children undergoing MRI without any significant adverse events.

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Retrospective Comparison of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response Exams

Cited by 31 publications

References 27 publications

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

A prospective, randomized, double‐blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing

Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial

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