Impact of Anesthesia Strategy on Infant Pulmonary Function Test Quality and Duration

TL;DR

This study compares different sedation methods for infant pulmonary function tests, finding that ketamine-midazolam, dexmedetomidine, and polypharmacy are safe and effective alternatives to chloral hydrate.

Contribution

The study provides preliminary evidence on the safety and efficacy of alternative sedation strategies for infant pulmonary function testing during chloral hydrate shortages.

Findings

Ketamine-midazolam and dexmedetomidine had shorter procedure and induction times compared to chloral hydrate.

Polypharmacy sedation resulted in longer total testing times compared to chloral hydrate.

All sedation strategies had similar test quality and only mild adverse events.

Abstract

While chloral hydrate (CH) has been standard for infant pulmonary function testing (iPFT) sedation, CH shortages are necessitating use of different sedation approaches. We aimed to compare the safety, test duration, and test quality of alternative sedation strategies for iPFT.

We conducted a retrospective chart review of iPFT conducted at our center from January 2019 to December 2021. We manually abstracted patient demographics, sedation medications given, adverse events, and iPFT type (raised volume‐rapid thoracic compression, plethysmography, bronchodilator response, and/or multiple breath washout), duration (induction, procedure, recovery, and total times), and quality (satisfactory vs unsatisfactory), then compared features of tests conducted with CH to tests conducted with ketamine and midazolam (KM), dexmedetomidine (DX), or multiple agents (polypharmacy, PP) using bivariate and multivariable analysis.

Sixty‐six children had iPFT (CH n = 42, KM n = 10, PP n = 8, and DX n = 6). Testing types and proportion of satisfactory tests did not significantly differ between CH and the other sedation strategies. In the multivariable analysis, compared to CH, we found that procedure time was shorter for KM, induction time was shorter for DX, and recovery time was longer for DX, yet total testing duration did not differ between CH and KM (p = 0.61) or DX (p = 0.22). In adjusted analyses, total testing time was longer for PP compared to CH (β = 12.0 min, p = 0.047). Adverse events, all of which were mild, occurred in three patients (PP n = 2, DX n = 1).

Our findings provide preliminary evidence that KM, DX, and PP may be safe and effective alternatives to CH for iPFT sedation.

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