Anaesthetic Management for Cochlear Implantation inpaediatric patients

Abstract

Deaf child has limited ability to communicate with the world. Early recognition and treatment of hearing loss in children is therefore mandatory to help them acquire language skills necessary for learning and participation effectively in their community. Hearing loss can be conductive, sensorineural or both. Different external hearing aids that amplify the sound signals help those with conductive HL or mild to moderate SNHL, while those with profound SNHL find them useless. Cochlear implant is an expensive electronic device which can convert sound signals into electrical impulse giving those children with profound SNHL the hope to hear again. However, it recquires a surgical operation to place the electrodes inside the ear. Anaesthesiologist's rule in cochlear implantation in paediatrics is crucial. Where it involves not only the care of a small child taking in mind all the physiological, anatomical, pharmacological and psychological differences from adults in order to provide safe and adecquate anaesthesia but also the ability to maintain the best conditions for performing the surgery in a blood less field together with minimizing the interference of the anaesthetic agents on the intraoperative tests necessary to check the integrity of the facial nerve and to set the limits of the device stimulation. Proper haemostasis before positioning the implant is necessary because cautary is prohibited thereafter to not damage the tiny electrodes of the implant. Smooth recovery is recommended so not to displace the electrodes by the agitated child by extubation in deep plane of anaesthesia, providing adecquate analgesia and taking all means to prevent PONV. Patients with a CI in place shouldn't undergo any procedure that may cause damage of the electrodes, however if MRI scanning is necessary, the external magnet is removed surgically to be replaced later.