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Li Y, Li Q, Zhao G, Zhang H, Zhong H, Zeng Y. Nalbuphine in Pediatric Emergence Agitation Following Cochlear Implantation: A Randomized Trial. Drug Des Devel Ther 2024; 18:2837-2845. [PMID: 39006192 PMCID: PMC11244056 DOI: 10.2147/dddt.s451089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/30/2024] [Indexed: 07/16/2024] Open
Abstract
Background To investigate the effects of nalbuphine on emergency agitation (EA), which affects up to 80% of the children following otolaryngology procedures, in children undergoing cochlear implantation. Methods A prospective double-blinded randomized controlled clinical trial was conducted between November 2020 and October 2022. Eligible children, aged 6 months to 3 years old, were randomly assigned to either 0.1 mg/kg, 0.15 mg/kg, 0.2 mg/kg nalbuphine or 0.9% saline groups. EA was defined by the Pediatric Anesthesia Emergence Delirium (PAED) score ≥10. Extubation time, post-anesthesia care unit (PACU) length of stay, severe EA (PAED ≥ 15), peak PAED score, the Faces, Legs, Activity, Cry, and Consolability (FLACC) scale, Ramsay sedation score, and adverse events were also recorded. Results A total of 104 children were enrolled, with 26 children in each group. Nalbuphine significantly reduced the EA occurrence from 73.1% in the saline group to 38.5%, 30.8%, and 26.9% in the 0.1 mg/kg, 0.15 mg/kg, and 0.2 mg/kg nalbuphine groups, respectively (P < 0.001), without affecting the extubation time and PACU length of stay. More children (34.6%) in the 0.9% saline group experienced severe EA. Higher dose nalbuphine (0.15 mg/kg, 0.2 mg/kg) showed lower peak PAED score, better analgesia and sedation effect compared with 0.1 mg/kg nalbuphine and saline groups. However, 0.2mg/kg nalbuphine caused undesired over-sedation in two (7.7%) children. No other adverse events were reported. Conclusion Young children undergoing cochlear implantation surgery were at a high risk of EA and postoperative pain, while 0.2 mg/kg nalbuphine might be an ideal candidate for EA and pain prevention when used under close monitoring. Trial Registration ChiCTR2000040407.
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Affiliation(s)
- Yan Li
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Qi Li
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Guangchao Zhao
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Haopeng Zhang
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Haixing Zhong
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
| | - Yi Zeng
- Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China
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Gowrishankar SV, Fleet A, Tomasoni M, Durham R, Umeria R, Merchant SA, Shah SFH, Muzaffar J, Mohammed H, Kuhn I, Tysome J, Smith ME, Donnelly N, Axon P, Bance M, Borsetto D. The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:467-481. [PMID: 36864717 DOI: 10.1002/ohn.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. DATA SOURCES MEDLINE, Embase, and Cochrane Library. REVIEW METHODS This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models. RESULTS A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta-analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. CONCLUSION Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.
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Affiliation(s)
- Shravan V Gowrishankar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Alex Fleet
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Michele Tomasoni
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rory Durham
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Rishi Umeria
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Serena A Merchant
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Syed F H Shah
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jameel Muzaffar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Cambridge University Medical Library, Cambridge, UK
| | - James Tysome
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Matthew E Smith
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Neil Donnelly
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Patrick Axon
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Daniele Borsetto
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Wu SS, Sbeih F, Anne S, Cohen MS, Schwartz S, Liu YCC, Appachi S. Auditory Outcomes in Children Who Undergo Cochlear Implantation Before 12 Months of Age: A Systematic Review. Otolaryngol Head Neck Surg 2023; 169:210-220. [PMID: 36939587 DOI: 10.1002/ohn.284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/20/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To systematically review the literature to determine auditory outcomes of cochlear implantation in children ≤12 months old. DATA SOURCE PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases were searched from inception to 9/1/2021 using PRISMA guidelines. REVIEW METHODS Studies analyzing auditory outcomes after cochlear implantation (CI) in children ≤12 months of age were included. Non-English studies and case reports were excluded. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Heterogeneity and bias across studies were evaluated. RESULTS Of 305 articles identified, 17 met inclusion criteria. There were 642 children ages 2 to 12 months at CI. The most common etiologies of hearing loss were congenital CMV, meningitis, idiopathic hearing loss, and GJB2 mutations and other genetic causes. All studies concluded that early CI was safe. Overall, outcomes improved following early CI: IT-MAIS (9 studies), LittlEARS (4 studies), PTA (3 studies), CAP (3 studies), GASP (3 studies), and LNT (3 studies). Nine studies compared outcomes to an older implantation group (>12 months); of these (n = 450 early CI, n = 1189 late CI), 8 studies showed earlier CI achieved comparable or better auditory outcomes than later implantation, whereas 1 study (n = 120) concluded no differences in speech perception improvement. CONCLUSION Auditory outcomes were overall improved in children ≤12 months old undergoing CI. Studies that compared early to late CI demonstrated similar or better auditory outcomes in early implantation group. Given the comparable safety profile and critical time period of speech and language acquisition, earlier CI should be considered for infants with hearing loss.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Firas Sbeih
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael S Cohen
- Department of Otolaryngology, Head and Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth Schwartz
- Department of Pediatric Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Yi-Chun C Liu
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Bruijnzeel H, Wammes E, Stokroos RJ, Topsakal V, de Graaff JC. A retrospective cohort study of adverse event assessment during anesthesia-related procedures for cochlear implant candidacy assessment and cochlear implantation in infants and toddlers. Paediatr Anaesth 2020; 30:1033-1040. [PMID: 32506586 PMCID: PMC7590089 DOI: 10.1111/pan.13944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cochlear implantation in children with sensorineural hearing loss is preferably performed at youngest age because early auditory input is essential to prevent neural plasticity decline. In contrast, the rate of anesthetic adverse events is increased during infancy. Therefore, to provide recommendations regarding an optimal pediatric implantation age, these possible anesthetic risks in infants need to be taken into account. AIMS This study aimed at assessing the relation between the age at cochlear implant surgery and anesthetic and surgical adverse events. Secondary aims were to evaluate anesthetic and surgical adverse events in relation to (a) the number of preoperative anesthesia-related procedures for cochlear implant candidacy assessment and (b) the anesthetic maintenance agent (total intravenous anesthesia versus inhalation anesthesia) during implantation. METHODS We executed a retrospective cohort study to evaluate cochlear implantation performed in infants and toddlers between January 2008 and July 2015 in a tertiary pediatric center. We compared anesthetic and surgical adverse events between age-at-implantation (0-12 and 12-24 months of age) groups. Furthermore, we assessed whether anesthetic adverse events occurred during preoperative anesthesia-related procedures for cochlear implant candidacy assessment. RESULTS Forty-six cochlear implantations were performed in 43 patients requiring 42 preoperative anesthesia-related procedures. Nineteen cochlear implantations (41.3%) were performed during infancy. During implantation, the maintenance agent was either sevoflurane (n = 22) or propofol (n = 24). None of the patients encountered major anesthetic adverse events, whereas minor adverse events occurred during 34 cochlear implantations. Those attributed to surgery occurred following six implantations. Neither the age at implantation nor the anesthetic maintenance agent was significantly related to the occurrence of both types of adverse events. CONCLUSIONS Adverse events occur independent of the age at implantation, the number of anesthetic preoperative procedures, and the type of anesthetic maintenance agent in patients who received a cochlear implant before 24 months of age.
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Affiliation(s)
- Hanneke Bruijnzeel
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands,Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands
| | - Emily Wammes
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Robert J. Stokroos
- Department of Otolaryngology and Head & Neck SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands,Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands
| | - Vedat Topsakal
- Brain Center Rudolf MagnusUtrecht UniversityUtrechtThe Netherlands,Department of Otolaryngology and Head & Neck SurgeryUniversity Hospital AntwerpAntwerpBelgium
| | - Jurgen C. de Graaff
- Department of Anesthesiology, Erasmus MCSophia Children's HospitalRotterdamThe Netherlands
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Kalugina MS, Rusetskiy YY, Aleksandrov AE, Alekseeva EA, Pashkov AV, Gadaleva SV, Arutyunyan SK. [General anesthesia influence on cochlear implant intraoperative testing]. Vestn Otorinolaringol 2019; 84:26-31. [PMID: 31793523 DOI: 10.17116/otorino20198405126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article, we consider the influence of combined general anesthesia on the results of electrically-involved stapedial reflex threshold (esrt) registration. We pay a special attention to the anesthesia to exclude its influence on the esrt. This study included 52 patients with bilateral chronic neurosensory hearing impairment. We conducted a retrospective (from 2014 to 2016) and prospective (from 2017 to 2018) analysis of anesthesia protocols. Even though the inhaled anesthesia (sevoflurane in this case) has a depressive effect on esrt registration (the higher the minimal alveolar concentration of anesthetic agent, the higher the reflex threshold), our study shows a possibility of using it in an extended anesthesia monitoring. Inclusion of myorelaxants in cochlear implantation anesthesia protocol not only provides a safe anesthesia, but also does not prevent a timely intraoperative cochlear implant testing.
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Affiliation(s)
- M S Kalugina
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - Yu Yu Rusetskiy
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - A E Aleksandrov
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - E A Alekseeva
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - A V Pashkov
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - S V Gadaleva
- Sechenov First Moscow State Medical University Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
| | - S K Arutyunyan
- Federal State Autonomous Institution 'National Medical Research Center Of Children's Health' Of Ministry Of Healthcare Of Russia, Moscow, Russia, 119991
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Musser AB, Golub JS, Samy RN, Phero JC. Intraoperative seizure and cerebrospinal fluid leak during adult cochlear implant surgery. Cochlear Implants Int 2016; 17:116-9. [PMID: 26843205 DOI: 10.1080/14670100.2015.1112571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE AND IMPORTANCE To report a rare case of cerebrospinal fluid gusher and subsequent seizure immediately after cochlear implant electrode insertion. CLINICAL PRESENTATION After the cochlear implant electrode was inserted, brisk flow of 10 mL of cerebrospinal fluid was seen. The electrode was promptly inserted and the leak was additionally sealed with fascia. Seconds later, the patient had a tonic-clonic seizure lasting 30 seconds. Two additional episodes occurred during the case. Her postoperative course was uneventful with no subsequent seizures. The device has been successfully activated. Intervention & Technique: Postoperative imaging showed correct intracochlear placement of the electrode as well as an incidental enlarged vestibular aqueduct. Neurology consultation including electroencephalogram was unremarkable. CONCLUSION To our knowledge, this is the first report of a seizure temporally associated with cochlear implant electrode insertion. The significance and possible casual relationship between these two events is discussed.
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Affiliation(s)
- Alexander B Musser
- a Departments of Surgery, Division of Oral and Maxillofacial Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Justin S Golub
- b Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center , CIncinnati , OH , USA.,d Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA.,e Department of Otolaryngology-Head and Neck Surgery , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - Ravi N Samy
- b Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center , CIncinnati , OH , USA.,d Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA
| | - James C Phero
- c Department of Anesthesiology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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