Open AccessANALYSIS OF THE EFFICIENCY OF EXTENDED INTRA-OPERATING MONITORING IN PERFORMING COCHLEAR IMPLANTATIONS
Author(s) -
Margarita S. Kalugina,
А Е Александров,
Yu.Yu. Rusetsky,
Е. А. Алексеева,
S. P. Yatsyk
Publication year - 2019
Publication title -
detskaâ hirurgiâ
Language(s) - English
Resource type - Journals
eISSN - 2412-0677
pISSN - 1560-9510
DOI - 10.18821/1560-9510-2019-23-1-23-26
Subject(s) - audiology , environmental science , medicine
. Cochlear implantation is a recognized treatment method for patients with severe and deep neurosensory hearing loss. To adjust the parameters of the speech processor of a cochlear implant (CI), the implementation of subjective techniques is not always possible, especially for younger patients. A good starting point for determining patient comfort levels during the initial connection of a speech processor is the intraoperatively obtained data of objective methods, one of which is the registration of an electrically induced stapedial reflex (EISR). Due to the marked effect of general anesthesia on the results of testing of CI and the lack of a universal anesthesiological protocol for this surgical intervention, the purpose of the study is to study the effectiveness of using extended intraoperative monitoring during testing of CI. Material and methods. The study included two groups, each consisting of 26 patients aged from 1 year to 15 years with a diagnosis of chronic sensorineural hearing loss. All children were installed CI delivered by company Med El (Austria). In the 1st group, data from medical records were analyzed retrospectively (anesthetic patient card and ESRT threshold values registration card during anesthesia and standard anesthesia monitoring volume). In the 2nd group of patients, intraoperative monitoring of anesthesia was extended by continuous evaluation of EEG (BIS-index) and indices of the degree of myoplegia. CI testing in this group was carried out in the recovery phase of neuro-muscular conductivity (4 TOF responses) and with BIS-index values from 60 to 80, which corresponded to sedation during drug sleep. Results. In the course of the work done in two groups of patients, the average values of intermediate points of the ESRT were analyzed, a comparative assessment of hemodynamic parameters at the main stages of the operation was carried out, and the optimal values of the minimum alveolar concentration of sevoflurane anesthetic and BIS index were determined for timely registration of the movement of stapedial muscle by the surgeon.