Cochlear implantation under local anesthesia with the use of Dexdor

The article presents material devoted to an urgent problem — rehabilitation of patients with sensorineural hearing loss of the IV degree and deafness with concomitant diseases. The authors present their own experience of cochlear implantation (CI) surgery in patients with concomitant somatic pathology under local infiltration anesthesia with intravenous sedation with dexmedetomidine. Dexmedetomidine is a relatively new drug used for sedation in anesthesiology and intensive care.

Material and Methods: In the Department of Ear Diseases of the SCC of Otorhinolaryngology, CI was performed in 10 patients with concomitant diseases, contraindicative for general anesthesia application, using local infiltration anesthesia with intravenous sedation by dexmedetomidine (Dexdor). In the preoperative period, all the patients were carefully prepared, each stage of the operation discussed, including the tables for intraoperative dialogue. CI was performed by the classical method: antromastoidotomy, posterior tympanotomy, opening of the secondary membrane, insertion of an electrode, intraoperative measurements and implant testing, wound closure layer by layer. Also, after the operation, a survey was conducted concerning all the parameters during the operation and in the early postoperative period.

Results. In all 10 cases, patients with concomitant diseases underwent CI under local anesthesia sol. Ultracaini – 8.0 with the use of dexmedetomidine, which helped to avoid the administration of myorelaxants. The surgery was performed in standard way under the control of an OMPI Sensera S7 Karl Zeiss microscope. After parenteral administration of the drug, the effect was achieved quickly enough, blood pressure during the administration did not reach high levels, no concomitant diseases were aggravated, patients felt satisfactory, responded to all signs, and answered questions reading from the tables. None of the patients felt pain during incision, soft tissue separation, boron machine working, insertion of the cochlear implant electrode array and its subsequent testing. Using tables for conversation, all patients received information about each stage of the operation and the subsequent actions of the surgical team and audiologists. At all stages of the operation, all patients did not experience any pain, only slight dizziness and discomfort during opening of the secondary membrane of the round window, insertion of the electrode array into the tympanum ladder and testing of the implant. Most patients were not in a deep sleep state, periodically waking up only in cases when it was necessary to inform them of the progress of the operation. Performing CI under local anesthesia allows to get clear thresholds for recording the acoustic reflexes (due to the myorelaxants effect exclusion) from stapedius muscle tendon. The operation time took 18±5.2 minutes on average, taking into account the time of anesthesia, which was 15±5.3 minutes less than in cases of tracheal intubation using myorelaxants.

Conclusions. The advantages of local anesthesia with the use of dexmedetomidine include less invasiveness of the procedure, the ability to not use myorelaxants, cost saving, the patient staying conscious (tracheal intubation is not required), which makes it possible to perform intraoperative testing of the implant and evaluate the patient’s auditory perception when signals are given, determining the presence or absence of pathological stimulation of the facial nerve, reduction of operation time, transfer to the ward (general regimen); the absence of nausea and vomiting in the early postoperative period, ability of patient (with concomitant diseases) to continue implementation of prescriptions by himself according to the scheme, a quick recovery of the general condition of the organism and a reduction in the postoperative period terms, and most importantly, the absence of intra- and postoperative complications associated with anesthesia.

Keywords: cochlear implantation, sedation, local anesthesia, anesthesia, rehabilitation

The authors declare no conflict of interest.

Source of financing: not specified.

For citation: Diab Kh.M., Daikhes N.A., Ryazanov V.B., Kaibov A.A., Pashchinina O.A., Mikhalevich A.E. Cochlear implantation under local anesthesia with the use of Dexdor. Golova i sheya. Rossijskij zhurnal Head and neck Russian Journal. 2019;7(4):53–60 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of pub-lishing illustrative material – tables, figures, photographs of patients.