Using melatonin to induce sleep as an alternative to general anaesthesia in auditory brainstem response testing

Objectives

Auditory Brainstem Response (ABR) is an objective, non-invasive hearing test requiring the subject to remain still for accurate results. This poses challenges in children with neurodevelopmental disabilities. Traditionally, general anaesthesia (GA) was employed, but it carries risks, high costs, and long waiting times. Melatonin, with minimal side effects and no need for monitoring, offers a potential alternative. This study evaluates the feasibility and efficacy of melatonin-induced sleep as an alternative for GA in ABR testing.

Methods

A retrospective review was conducted on 52 children with neurodevelopmental disabilities referred for ABR under melatonin-induced sleep at the Royal Hospital for Children, Glasgow, from July 2023 to November 2024. Pre-test sleep deprivation and a 9 mg dose of melatonin were used. Children with unsuccessful first tests were invited for a second attempt. If both attempts failed, GA was required.

Results

Of 47 attendees, 53 % achieved successful ABR testing on the first attempt, and 26.7 % at the second attempt. Cumulatively, 61.7 % did not require GA. No significant correlation was found between age, sex, or co-morbidities and success rates. Median GA ABR waiting times decreased by 25.8 %, and 26 children were removed from the GA waiting list. Cost analysis showed a 43.32 % saving per patient using melatonin-induced sleep compared to GA. Parent acceptability was high, irrespective of testing outcomes.

Conclusions

Melatonin-induced sleep is a feasible, cost-effective alternative to GA for ABR testing. Despite the relatively low success rates, it reduces waiting times, lowers costs, and minimises the need for GA.