Brainstem Auditory Evoked Response (BAER)

Background:

• Indications

  • Failed hearing screening

  • Meningitis with concern for hearing loss

• Patient Considerations

  • Patients may have other developmental delays and/or syndromes

  • Patients with recent meningitis may have active URI symptoms

• Disease Specific Considerations

  • May be combined with an Ear EUA and BMT

Anesthetic Management:

• Case Planning

  • Thorough Pre-Anesthetic Evaluation including identification and optimization of comorbid conditions

• Specific or Unique Room Set-Up Requirements

  • None

• Airway

  • LMA v. ETT

• Drugs/Infusions

  • Consider PONV and emergence delirium prophylaxis

  • Electrode placement may be stimulating but procedure has little post-op pain

• Monitors

  • Standard ASA Monitors

• Blood Availability

  • Not required

• PICU Bed Availability

  • Not required

• Anesthetic Considerations

  • Monitor volume should be decreased to minimize impact on test quality

  • Auditory Evoked Responses are very resistant to interference from volatile anesthetics

    • Does not require modification of anesthetic plan

• Induction

  • Frequently mask induction followed by PIV and LMA placement

• Positioning

  • Supine

• Maintenance

  • Volatile anesthesia

• Hemodynamic/Physiologic goals

  • No special goals

• Surgical Considerations (such as neuromonitoring, muscle relaxation, anticipated blood loss)

  • Monitor volume should be decreased to minimize impact on test quality

• Emergence/Disposition

  • Appropriate patients may be extubated and taken to PACU deep

• Post-Op Pain Management

  • Non-opioid pain medications usually sufficient

• Case-Specific Complications

  • OR Noise impacting quality of study