Jöhr Martin, Ho Ambrose, Wagner Christoph Schlegel, Linder Thomas
Paediatric Anesthesia, Department of Anesthesia, Kantonsspital, Luzern, Switzerland.
Otol Neurotol. 2008 Apr;29(3):310-3. doi: 10.1097/MAO.0b013e3181661866.
Neonatal hearing screening programs allow early identification of infants with congenital severe hearing impairment. Increasing evidence suggests that early cochlear implantation (CI) facilitates auditory rehabilitation and bilateral implantation exceeds the benefit of unilateral CI fitting. Elective surgery before the age of 12 months has, therefore, become increasingly popular. A team approach between the surgeon and the anesthesia team is required to guarantee the safety for the patient. The implanting surgeon should also be aware of the special constraints relevant at this age group.
Our personal experience at a tertiary children's hospital and a review of the German and English literature published on this subject between 1980 and 2007.
Tertiary referral otology and skull base center with affiliated children's hospital.
Patients younger than 1 year of age undergoing CI surgeries were analyzed concerning surgical techniques, and anesthesiological aspects of elective surgeries in small infants were evaluated.
The main focus was on CI surgeries in very young infants. Risk factors involving the surgical planning, intervention, and perioperative anesthesia care were evaluated.
The age of the patient and the pediatric experience of the anesthesiologist, but not the duration of the surgery, are relevant risk factors. This review article is intended to highlight the surgical and anesthesiological considerations when performing CI surgery in very young infants and anticipates familiarizing the implanting surgeon with important aspects of hemostasis, pharmacokinetics, and cardiopulmonary reserves in small pediatric patients.
Elective ear surgery in infants below 1 year of age should be performed in institutions where a continuous experience with this type of patient exists and all the facilities of pediatric perioperative anesthesia care are readily available.
新生儿听力筛查项目有助于早期识别患有先天性重度听力障碍的婴儿。越来越多的证据表明，早期人工耳蜗植入（CI）有助于听觉康复，双侧植入比单侧CI植入的益处更大。因此，12个月龄前的择期手术越来越普遍。需要外科医生和麻醉团队采用团队协作方法来确保患者的安全。植入外科医生还应了解该年龄组相关的特殊限制因素。
我们在一家三级儿童医院的个人经验以及对1980年至2007年间发表的关于该主题的德语和英语文献的综述。
设有附属儿童医院的三级转诊耳科和颅底中心。
对年龄小于1岁接受CI手术的患者的手术技术进行分析，并评估小婴儿择期手术的麻醉方面。
主要关注非常小的婴儿的CI手术。评估涉及手术规划、干预和围手术期麻醉护理的风险因素。
患者年龄和麻醉医生的儿科经验是相关风险因素，而手术持续时间不是。这篇综述文章旨在强调对非常小的婴儿进行CI手术时的手术和麻醉注意事项，并期望使植入外科医生熟悉小儿患者止血、药代动力学和心肺储备的重要方面。
1岁以下婴儿的择期耳部手术应在有此类患者持续治疗经验且具备小儿围手术期麻醉护理所有设施的机构中进行。
