Implementing neonatal hearing screening has significantly reduced the age at which hearing impairments are detected in children. Nevertheless, objective electrophysiological assessments, such as auditory brainstem response (ABR) or auditory steady-state response (ASSR) testing, are often necessary for children older than six months. These evaluations should be conducted while the child is asleep to obtain accurate and interpretable results, as movement and muscle activity can introduce artifacts that compromise the quality of the recordings. In this narrative review, we evaluate sedation strategies in paediatric procedures, focusing on the efficacy, safety, and practicality of agents/routes for inducing sleep during ABR/ASSR testing. Sedation choices should prioritise patient safety, clinical context, and result reliability and be tailored to the individual’s age, health status, and procedural needs.

Background/Objectives: The implementing of neonatal hearing screening has significantly reduced the age at which hearing impairments are detected in children. Nevertheless, objective electrophysiological assessments, such as Auditory Brainstem Response (ABR) or Auditory Steady-State Response (ASSR) testing, are often necessary for children older than six months. To obtain accurate and interpretable results, these evaluations should be conducted while the child is asleep, as movement and muscle activity can introduce artifacts that compromise the quality of the recordings. Methods: This narrative review examines data from the literature presenting various sedation strategies employed to facilitate sleep in pediatric patients undergoing different types of procedures. It focuses on the efficacy, safety, and practicality of different sedative agents and administration routes. Results: Several sedation methods are utilized in clinical practice to achieve the necessary sleep state for ABR and ASSR testing in children. Sedatives, such as intranasal dexmedetomidine, oral midazolam, and combinations like ketamine-midazolam, have also been used, each with varying degrees of efficacy and safety profiles. General anesthesia is typically reserved for cases where less invasive sedation methods are contraindicated or have proven ineffective. Conclusions: While natural sleep is ideal for ABR and ASSR testing, sedation using agents that can be administered orally or intranasally provides a practical alternative, enabling testing outside the operating theatre. General anesthesia should be considered when non-invasive sedation is not feasible or contraindicated. The choice of sedation method should be individualized based on the child’s age, medical history, and specific needs, ensuring safety for the patient and reliability of the results.