Use of Sedation in the Evaluation Process
No child, especially those under the age of six months of age, should be given medication to sedate for testing unless absolutely necessary. Sedating merely for convenience or to speed testing time in a busy clinic schedule is neither ethical audiological practice nor good medical practice. Most normally developing children from birth to 6 months of age can be tested using sleep deprivation and other techniques to induce natural sleep.
The standard is to begin with less medically invasive procedures (i.e. behavioral) and move to more complex procedures (i.e. electrophysiological) requiring or including the use of sedation only when deemed necessary to complete the evaluation.
Children 6 months and older or children with complex medical conditions may need to be sedated to complete necessary diagnostic procedures when behavioral audiology is inappropriate due to the child's age or other limitations or attempts at behavioral testing have been made with no success. Conscious sedation is recommended over deep sedation whenever possible.
Administering the sedation and discharging patients after the procedure is not within the scope of practice of the audiologist.
"Moderate Sedation: To gain the cooperation of some infants and young children during physiologic assessments of auditory function, sedation may be required. Yet, sedation of pediatric patients has serious associated risks such as hypoventilation, apnea, airway obstruction, and cardiopulmonary impairment. Consequently, sedative medications should only be administered by or in the presence of individuals skilled in airway management and cardiopulmonary resuscitation. Additionally, the oversight by skilled medical personnel and the availability of age and size-appropriate equipment, medications, and continuous monitoring are essential during procedures and in rescuing the child should an adverse sedation event occur.
The JCAHO has adopted revisions to its anesthesia care standards (JCAHO, 2002), consistent with the standards of the American Society of Anesthesiologists (American Society of Anesthesiologists, 2002). The most current terminology of the American Society of Anesthesiologists has replaced the term conscious sedation with moderate sedation."
ASHA Guidelines for the Audiologic Assessment of Children From Birth to 5 Years of Age