Conscious sedation and local anesthesia for patients undergoing neurotologic and complex otologic procedures.

Abstract

OBJECTIVE:

Is conscious sedation an effective, safe, and efficient anesthetic choice in patients undergoing select neurotologic and otologic procedures?

STUDY DESIGN:

Retrospective case review.

SETTING:

Tertiary referral center.

PATIENTS:

Six patients underwent eight neurotologic procedures including cerebrospinal fluid leak and encephalocele repair, and primary and revision cochlear implant surgery. Patients were deemed poor candidates for general anesthesia secondary to medical comorbidities. These were compared to 11 control patients who underwent same procedures under general anesthesia with intubation.

INTERVENTION:

Dexmedetomidine infusion was utilized as the primary agent for conscious sedation in this high-risk patient population because, unlike other commonly used sedatives, it preserves normal respirations while providing adequate analgesia.

MAIN OUTCOME MEASURES:

Preoperative Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) scores were calculated for the study group. We measured total anesthesia, and perioperative and recovery times. Cost of anesthetic agents was considered and any adverse effects were noted. Patient satisfaction with the operative experience was assessed with telephone surveys.

RESULTS:

P-POSSUM scores were high for the study group. Postoperative anesthesia was shorter for the study patients undergoing conscious sedation. Difference in cost of anesthetic agents was negligible. The adverse effects were few and as expected for the type of procedure. Patients reported satisfaction and comfort with their operative experience.

CONCLUSION:

Select neurotologic and otologic procedures can be safely, effectively, and efficiently performed under conscious sedation with dexmedetomidine infusion as the primary anesthetic choice for patients who are deemed poor medical candidates for general endotracheal anesthesia.

• Authors: Maja Svrakic, Aron Pollack, T Kate Huncke, J Thomas Roland Jr
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 35 Issue 10 Pg. e277-85 (Dec 2014) ISSN: 1537-4505 [Electronic] United States
• PMID: 25226374 (Publication Type: Journal Article)

Chemical References

• Hypnotics and Sedatives

Topics

• Adult
• Aged
• Aged, 80 and over
• Anesthesia, Local
• Cerebrospinal Fluid Leak (surgery)
• Conscious Sedation
• Encephalocele (surgery)
• Female
• Humans
• Hypnotics and Sedatives
• Male
• Middle Aged
• Neurosurgical Procedures (methods)
• Otologic Surgical Procedures (methods)
• Patient Satisfaction
• Reoperation
• Retrospective Studies
• Treatment Outcome