Impact of anesthetics choice on auditory brainstem response testing in children: A systematic review

OBJECTIVE Critically appraise the literature for anesthetic agents and routes of administration and their impacts on successful sedation and auditory brainstem response (ABR) testing outcomes in children. METHODS Searches of PubMed, Cochrane, and Web of Science for all available literature, last accessed February 2025, using "auditory brainstem response", "anesthesia", "anesthetic", "IV anesthesia", "volatile anesthesia", "oral anesthesia", "pediatric", "sevoflurane", and "hearing loss" with "AND". Non-English, non-pediatric, studies unrelated to anesthetic agents and ABR were excluded. RESULTS 510 studies screened, 24 included (6053 patients (35.2 % female)). Eight studies with 282 patients reported the impact of different anesthetics on ABR waveforms, and sixteen with 5771 participants reported the rate of successful sedation. Sixty-nine patients from three studies demonstrated no significant difference in waveforms among different anesthetic agents. Four studies with 144 participants reported significant alterations of waveforms between pharmacologic and non-anesthetized groups. One study with 79 participants found that sevoflurane produced more false positives, resulting in more severe hearing loss diagnoses than propofol. Anesthetic agents with various routes of administration demonstrated different levels of efficacy in achieving sedation, with IV propofol and intranasal dexmedetomidine exhibiting improved performance. CONCLUSION Current literature demonstrates the use of multiple anesthetic agents and routes of administration during ABR testing in children with varying degrees of successful sedation and extent of impact on ABR waveforms. Limited data suggest that IV propofol is highly effective in achieving sedation with a lower impact on ABR testing outcomes. Nevertheless, further investigation is required to guide anesthetic selection during ABR testing in children.