Anesthetic Management of Cochlear Implant Surgery in a Patient with Alport Syndrome

Background: Cochlear implants are now an acceptable therapeutic option for those patients with irreversible hearing loss and deaf-mutism. The surgery is time consuming and complicated. Hence, the technique of anaesthesia plays a crucial role in success of cochlear implant surgery. Cochlear implant patients have various types of syndromes which are important from anaesthetic as well as surgical point of view. Pre-implant preparation requires objective assessment of hearing, plain X-rays of skull and a CT scan of the temporal bone. Anaesthesia is required for objective assessment of hearing in children under five years of age, to obtain X-rays of skull, Magnetic Resonance Imaging (MRI), CT scan, Brain Evoked Response Audiometry (BERA) testing and finally for cochlear implant surgery. Anaesthetic considerations include preoperative familiarisation with the patient and his family. Syndromal illnesses have specific anaesthetic significance such as presence of difficult airway or prolonged QT interval. Parental presence is highly desirable during induction of anaesthesia. Electro-surgical instruments especially monopolar ones, should not be used once the cochlear implant is in place. Aim: To provide a standard balanced anesthetic management in a patient with Alport Syndrome with sensorineural hearing loss and post renal transplant posted for cochlear implant surgery. Material & Methods: The case includes an eight year old male child with post renal transplant surgery with Alport syndrome where in care has been taken to maintain adequate hemodynamic status & renal function with efficient anesthetic administration. The technique of general anaesthesia was modified to permit use of nerve stimulators during surgery. To minimize the incidence of vertigo particularly after cochleostomy, postoperative nausea and vomiting, the patient received glycopyrrolate and fentanyl citrate intravenously prior to induction. Other agents used were, thiopentone, suxamethoniumand end-tidal 1 MAC sevofluranein 1:2 mixture of oxygen and nitrous oxide (O2 and N2 O). Electro diathermy was switched off, before the cochlear device was implanted on the patient. Patient was allowed to breathe spontaneously whenever nerve stimulator was used to locate the facial nerve. Inj Ondansetron 0.1 mg/kg was used as anti-emetic agent. Postoperative pain relief was initially provided with fentanyl 1 μg/kg IV and later with syrup ibuprofen. Conclusion: The study throws light upon the precautions & preliminary methods followed in providing balanced anesthesia to the patient of Alport syndrome with renal transplant undergoing the cochlear implant surgery. Complicated patients with syndromic features have to be managed carefully in order to avoid various anesthetic complications. There was no remarkable anaesthetic or surgical complication Received: October 03, 2017; Accepted: October 27, 2017, Published: November 04, 2017 *Corresponding author: Pavithra V, Resident, Department of Anesthesiology, BJ Medical College, Ahmadabad, India, Tel.: 7022044720; E-mail: [email protected] Special Issue: Anesthesia & Critical Care