Author(s)
Phuong H. Bao, BS
David R. Friedland, MD, PhD
Jazzmyne Adams, MPH Julie K. Freed, MD, PhD
Masoud Khani, BS
Jake Luo, PhD
Affiliation(s)
Medical College of Wisconsin;
Abstract:
Objective: Otologic surgery has specific anesthetic requirements such as avoiding nitrous oxide and permitting facial nerve monitoring. However, little evidence exists for selecting the best anesthetic agent and it is often left to anesthesiologist preference.
Study Design: Retrospective review of 600 primary cochlear implant surgeries and associated anesthetic variables.
Setting: Tertiary academic medical center.
Patients: Adult patients undergoing cochlear implant surgery over 10 years by a single surgeon.
Interventions: Anesthesia regimen: Balanced, Gas, TIVA (total intravenous anesthesia).
Main Outcome Measures: 1) Emergence Time, 2) Time in Phases of Recovery, 3) Anesthetic agents
Results: Among 600 cochlear implant surgeries, a balanced regimen was most commonly used (84.3%) with less often use of gas (13.5%) or TIVA (2.2%) alone. Average surgical time was 72.1±18.5 minutes. Emergence from anesthesia averaged 13.7±5.4 minutes and was shortest with the use of TIVA (11.9±4.6 minutes) and longest with only gas (14.2±5.3 minutes). Univariate analyses demonstrated no statistically significant correlation between anesthesia regimen and emergence time, time in recovery, and time in phase II. Multivariate linear regression showed significantly shorter emergence times with TIVA anesthetic regimen versus gas alone (coeff: -5.29, p=.0027). No difference was noted by sex, race, or ASA class. Interestingly, N20 was administered in 18.8% of cases at an average of 8.3±18.3% without effect on emergence time.
Conclusions: TIVA anesthetic regimen is associated with shorter emergence time than gas alone. These findings may inform best practice for anesthesia in otologic surgical cases.
Professional Practice Gap & Educational Need: Balanced, gas, and TIVA are currently administered in cochlear implant surgery. A gap exists in the understanding of the relative efficacy of each anesthesia regimen relating to patient recovery.
Learning Objective: Understand recovery rates for cochlear implant surgery in different age demographics, anesthetics, anesthesia staffing, and anesthetic regimen.
Desired Result: For physicians to use evidence-based information when administering anesthesia during cochlear implant surgery.
Level of Evidence - IV
Indicate IRB or IACUC: PRO00045896