16th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
February 26-28, 2017 • Atlanta, GA
| Use of Dexmedetomidine for Sedation in Auditory Brainstem Response Testing
Sedation is widely used for ABR testing for children who cannot be successfully tested utilizing developmentally appropriate behavioral test techniques or for older infants who are not able to sleep naturally for ABR testing following an atypical new born hearing screening outcome. Sedated ABR testing often introduces delays in early identification of hearing loss as at some facilities it is necessary to utilize general anesthesia and to arrange for anesthesiology. Moderate sedation is an alternative which requires less intensive medical supervision and can be undertaken outside of an operating room environment. In anticipation that chloral hydrate would no longer be available, the team at KKI considered available medications for moderate sedation and decided on dexmedetomidine because of its safety profile including lack of respiratory depression and ease of administration. Dexmedetomidine is an anxiolytic, sedative, and analgesic medication which is similar to clonidine. The injectable formulation is administered into the nose using an atomizer. Onset of sedation is typically in about 20 to 30 minutes and lasts 60 to 90 minutes. A review of records revealed that complete audiological data were obtained on 94% of patients sedated with dexmedetomidine. In contrast, complete audiological data were obtained on 91% of patients sedated with choral hydrate in a period prior to the use of dexmedetomidine. Data was obtained for at least one ear on all patients. Effectiveness is defined as having obtained thresholds for the click and tone bursts centered at 500, 2000, and 4000 Hz for both ears. It is concluded that dexmedetomidine is as effective as chloral hydrate in producing an appropriate state for sedated AEPs. There were no sentinel events with dexmedetomidine. Dexmedetomidine was far easier to administer with a shorter onset time to sedation as well as a shorter recovery to discharge time than for chloral hydrate.
- Participants will become familiar with the properties and method of administration of dexmedetomidine.
- Participants will learn the expected onset time to sedation as well as the recovery to discharge time for moderate sedation with dexmedetomidine.
- Participants will learn the number of patients requiring more than one administration of dexmedetomidine in order to complete ABR testing.
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(), Kennedy Krieger Institute, email@example.com;
Ms. Sherry is a 4th Year Audiology LEND trainee at the Kennedy Krieger Institute. She is enrolled in the Doctoral program at Towson University.
(), Kennedy Krieger Institute, Levey@kennedykrieger.org;
Dr. Levey is a researcher and pediatrician specializing in the medical care of children with severe developmental disabilities. Currently, he serves as the medical director for both the Pediatric Feeding Disorders Continuum and PACT: Helping Children with Special Needs, and is the director of the Pediatric Pain Rehabilitation Program. He also serves as the associate medical director for the Carter Center for Brain Research in Holoprosencephaly and Related Malformations. He is an associate professor of pediatrics at the Johns Hopkins University School of Medicine.
(), Kennedy Krieger Institute, firstname.lastname@example.org;
Carolyn Gillen is the sedation nurse at Kennedy Krieger Institute. She is responsible for administering sedation and for monitoring the patients throughout the duration of ABR testing.
(), Kennedy Krieger Institute, email@example.com;
Dr. Pillion received his BA from Western Michigan University and his MA and Ph.D. from The Ohio State University. Dr. Pillion completed a post-doctoral fellowship in audiology at Kennedy Krieger from 1982 to 1984. He was Senior Audiologist at Kennedy Krieger Institute before becoming the Clinical Manager of Audiology in 1996 and the Director of the Department of Audiology in 1997. He is also an assistant professor in the Department of Physical Medicine and Rehabilitation of the Johns Hopkins University School of Medicine.
Financial - No relevant financial relationship exist.
Nonfinancial - No relevant nonfinancial relationship exist.