Bruijnzeel Hanneke, Wammes Emily, Stokroos Robert J, Topsakal Vedat, de Graaff Jurgen C
Department of Otolaryngology and Head & Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Brain Center Rudolf Magnus, Utrecht University, Utrecht, The Netherlands.
Paediatr Anaesth. 2020 Sep;30(9):1033-1040. doi: 10.1111/pan.13944. Epub 2020 Jul 30.
Cochlear implantation in children with sensorineural hearing loss is preferably performed at youngest age because early auditory input is essential to prevent neural plasticity decline. In contrast, the rate of anesthetic adverse events is increased during infancy. Therefore, to provide recommendations regarding an optimal pediatric implantation age, these possible anesthetic risks in infants need to be taken into account.
This study aimed at assessing the relation between the age at cochlear implant surgery and anesthetic and surgical adverse events. Secondary aims were to evaluate anesthetic and surgical adverse events in relation to (a) the number of preoperative anesthesia-related procedures for cochlear implant candidacy assessment and (b) the anesthetic maintenance agent (total intravenous anesthesia versus inhalation anesthesia) during implantation.
We executed a retrospective cohort study to evaluate cochlear implantation performed in infants and toddlers between January 2008 and July 2015 in a tertiary pediatric center. We compared anesthetic and surgical adverse events between age-at-implantation (0-12 and 12-24 months of age) groups. Furthermore, we assessed whether anesthetic adverse events occurred during preoperative anesthesia-related procedures for cochlear implant candidacy assessment.
Forty-six cochlear implantations were performed in 43 patients requiring 42 preoperative anesthesia-related procedures. Nineteen cochlear implantations (41.3%) were performed during infancy. During implantation, the maintenance agent was either sevoflurane (n = 22) or propofol (n = 24). None of the patients encountered major anesthetic adverse events, whereas minor adverse events occurred during 34 cochlear implantations. Those attributed to surgery occurred following six implantations. Neither the age at implantation nor the anesthetic maintenance agent was significantly related to the occurrence of both types of adverse events.
Adverse events occur independent of the age at implantation, the number of anesthetic preoperative procedures, and the type of anesthetic maintenance agent in patients who received a cochlear implant before 24 months of age.
感音神经性听力损失儿童的人工耳蜗植入最好在最年幼时进行，因为早期听觉输入对于防止神经可塑性下降至关重要。相比之下，婴儿期麻醉不良事件的发生率会增加。因此，为了提供关于最佳小儿植入年龄的建议，需要考虑婴儿期这些可能的麻醉风险。
本研究旨在评估人工耳蜗植入手术年龄与麻醉及手术不良事件之间的关系。次要目的是评估与（a）人工耳蜗植入候选资格评估的术前麻醉相关程序数量以及（b）植入期间的麻醉维持药物（全静脉麻醉与吸入麻醉）相关的麻醉及手术不良事件。
我们进行了一项回顾性队列研究，以评估2008年1月至2015年7月在一家三级儿科中心对婴幼儿进行的人工耳蜗植入情况。我们比较了植入年龄（0至12个月和12至24个月）组之间的麻醉及手术不良事件。此外，我们评估了在人工耳蜗植入候选资格评估的术前麻醉相关程序期间是否发生麻醉不良事件。
43例患者接受了46次人工耳蜗植入，需要进行42次术前麻醉相关程序。19次人工耳蜗植入（41.3%）在婴儿期进行。植入期间，维持药物为七氟醚（n = 22）或丙泊酚（n = 24）。没有患者发生重大麻醉不良事件，而在34次人工耳蜗植入期间发生了轻微不良事件。其中归因于手术的不良事件发生在6次植入之后。植入年龄和麻醉维持药物均与两种不良事件的发生无显著相关性。
在24个月前接受人工耳蜗植入的患者中，不良事件的发生与植入年龄、术前麻醉程序数量以及麻醉维持药物类型无关。
