Difference between revisions of "Cochlear implant surgery"

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| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
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}}'''Cochlear implant surgery''' is a novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve<ref>{{Cite journal|last=Naples|first=James G.|last2=Ruckenstein|first2=Michael J.|date=2020-02|title=Cochlear Implant|url=https://pubmed.ncbi.nlm.nih.gov/31677740|journal=Otolaryngologic Clinics of North America|volume=53|issue=1|pages=87–102|doi=10.1016/j.otc.2019.09.004|issn=1557-8259|pmid=31677740}}</ref><ref>{{Cite journal|last=Mowry|first=Sarah E.|last2=Woodson|first2=Erika|date=2020-01-01|title=Cochlear Implant Surgery|url=https://pubmed.ncbi.nlm.nih.gov/31556929|journal=JAMA otolaryngology-- head & neck surgery|volume=146|issue=1|pages=92|doi=10.1001/jamaoto.2019.2274|issn=2168-619X|pmid=31556929}}</ref>. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations. 


Cochlear implant surgery is novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve<ref>{{Cite journal|last=Naples|first=James G.|last2=Ruckenstein|first2=Michael J.|date=2020-02|title=Cochlear Implant|url=https://pubmed.ncbi.nlm.nih.gov/31677740|journal=Otolaryngologic Clinics of North America|volume=53|issue=1|pages=87–102|doi=10.1016/j.otc.2019.09.004|issn=1557-8259|pmid=31677740}}</ref><ref>{{Cite journal|last=Mowry|first=Sarah E.|last2=Woodson|first2=Erika|date=2020-01-01|title=Cochlear Implant Surgery|url=https://pubmed.ncbi.nlm.nih.gov/31556929|journal=JAMA otolaryngology-- head & neck surgery|volume=146|issue=1|pages=92|doi=10.1001/jamaoto.2019.2274|issn=2168-619X|pmid=31556929}}</ref>. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations. 
==Preoperative management==


== Preoperative management ==
===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
 
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
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|Neurologic
|Neurologic
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|Patients' hearing is limited
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|Cardiovascular
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|Respiratory
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|Gastrointestinal
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|Hematologic
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|Renal
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|Endocrine
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|Other
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
===Operating room setup===
 
*Standard GA setup
=== Operating room setup ===
*Consider straight connector with accordion to ETT
*Circuit extensions for 180-degree supine position


* Standard GA setup
* Consider straight connector with accordion to ETT
* Circuit extensions for 180-degree supine position


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
==Intraoperative management==


=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
*Facial nerve monitoring
*PIV (consider 2nd IV in lower extremity with 180-degree positioning)


== Intraoperative management ==
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
*GETA


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
===Positioning===
 
*180-degree turn (head is away from anesthesia team)
* Facial nerve monitoring
*Head positioned away from operating site.
* PIV (consider 2nd IV in lower extremity with 180-degree positioning)
*Surgeons may conduct frequent head position changes intraoperatively
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
 
* GETA
 
=== Positioning ===
 
* 180-degree turn (head is away from anesthesia team)
* Head positioned away from operating site.  
* Surgeons may conduct frequent head position changes intraoperatively  
 
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===


===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
* Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
* Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
* During microscopy, minimize patient movement
*During microscopy, minimize patient movement
* Volatile anesthetics are appropriate despite facial nerve monitoring
*Volatile anesthetics are appropriate despite facial nerve monitoring
 
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
 
== Postoperative management ==


=== Disposition ===
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===


* PACU
==Postoperative management==
* Home-discharge


=== Pain management ===
===Disposition===
*PACU
*Home discharge


* Oral narcotics
===Pain management===
* Multi-modal, non-narcotic medications
*Oral narcotics
*Multi-modal, non-narcotic medications


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===
*PONV


* PONV
==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==
 
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==


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!Suprameatal
!Suprameatal
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| Unique considerations
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== References ==
==References==


[[Category:Surgical procedures]]
[[Category:Surgical procedures]]
<references />

Revision as of 13:07, 11 July 2021

Cochlear implant surgery
Anesthesia type

General

Airway

ETT

Lines and access

PIV

Monitors

Standard; facial nerve monitoring

Primary anesthetic considerations
Preoperative

Patients' hearing is limited

Intraoperative

Facial nerve monitoring (avoid paralytics)

Postoperative
Article quality
Editor rating
Unrated
User likes
0

Cochlear implant surgery is a novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve[1][2]. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations.

Preoperative management

Patient evaluation

System Considerations
Neurologic Patients' hearing is limited

Operating room setup

  • Standard GA setup
  • Consider straight connector with accordion to ETT
  • Circuit extensions for 180-degree supine position


Intraoperative management

Monitoring and access

  • Facial nerve monitoring
  • PIV (consider 2nd IV in lower extremity with 180-degree positioning)

Induction and airway management

  • GETA

Positioning

  • 180-degree turn (head is away from anesthesia team)
  • Head positioned away from operating site.
  • Surgeons may conduct frequent head position changes intraoperatively

Maintenance and surgical considerations

  • Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
  • During microscopy, minimize patient movement
  • Volatile anesthetics are appropriate despite facial nerve monitoring

Emergence

Postoperative management

Disposition

  • PACU
  • Home discharge

Pain management

  • Oral narcotics
  • Multi-modal, non-narcotic medications

Potential complications

  • PONV

Procedure variants

Posterior

Tympanotomy

Suprameatal
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

  1. ↑ Naples, James G.; Ruckenstein, Michael J. (2020-02). "Cochlear Implant". Otolaryngologic Clinics of North America. 53 (1): 87–102. doi:10.1016/j.otc.2019.09.004. ISSN 1557-8259. PMID 31677740. Check date values in: |date= (help)
  2. ↑ Mowry, Sarah E.; Woodson, Erika (2020-01-01). "Cochlear Implant Surgery". JAMA otolaryngology-- head & neck surgery. 146 (1): 92. doi:10.1001/jamaoto.2019.2274. ISSN 2168-619X. PMID 31556929.

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