Cochlear implant surgery

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
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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. 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

• Patients' limited hearing may impair preoperative consultation

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

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