Adult Cochlear Implantation Under Local Anesthesia and Conscious Sedation with Dexmedetomidine: Efficacy and a Method to Interact with the Conscious and Cooperative Patient

BACKGROUND: This study describes the efficacy of cochlear implantation under local anesthesia with conscious sedation with dexmedetomidine in adult patients and proposes a method to communicate with the conscious and cooperative patient intraoperatively. This less invasive anesthetic procedure is suitable for patients with comorbidities preventing general anesthesia. METHODS: Unilateral cochlear implantation with Oticon Medical systems was performed in 10 adult patients with comorbidities preventing general anesthesia. Classical cochlear implantation was performed under local anesthesia and conscious sedation with dexmedetomidine. Cue cards were used to support intraoperative dialogue. Outcome measures were intraoperative adverse events, patient perceptions, as well as postoperative completions measured with a questionnaire. RESULTS: The procedure was successful for all 10 patients. Dexmedetomidine lead to rapid and successful conscious sedation and no case of high blood pressure or aggravation of comorbidities was noted. Stapedial reflex measurements led to reliable thresholds. The usage of the cue cards was successful: patients were able to read the cue cards and thereby the medical team could inform the patients of surgical progress and ask the patients questions. CONCLUSION: Cochlear implantation and intraoperative dialogue with the conscious and cooperative patient is possible. The main advantage of the anesthetic procedure is the reduction in intra- and postoperative complications. Further, expected benefits include a less invasive procedure, the conscious state of the patient which enables the recording of auditory perception, and the absence of nonauditory percepts such as facial nerve stimulation during implant stimulation, a shorter surgical duration, and lower-associated costs.