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Related Concept Videos

Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

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Updated: Jun 26, 2026

Robotic Cochlear Implantation for Direct Cochlear Access
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Adult Simultaneous Cochlear Implantation: Local Anesthesia.

Nawaf Fatani1, Asma Alahmadi1, Yousef Almassalmeh2

  • 1King Abdullah Ear Specialist Center, College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia.

Ear, Nose, & Throat Journal
|October 15, 2024
PubMed
Summary

Simultaneous bilateral cochlear implantation under local anesthesia with sedation is a safe and effective alternative for adults. This approach allows immediate device fitting and significantly improves hearing outcomes, offering a viable option for hearing rehabilitation.

Keywords:
adultscochlear implantgreen cochlearlocal anesthesiasimultaneous

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Anesthesiology

Background:

  • Cochlear implantation (CI) typically requires general anesthesia (GA), posing risks for some patients.
  • Local anesthesia (LA) is a viable alternative for single CI in patients unsuitable for GA.
  • The feasibility of simultaneous bilateral CI (BiCI) under LA with sedation remains less explored.

Purpose of the Study:

  • To evaluate the safety and efficacy of simultaneous bilateral cochlear implantation (BiCI) under local anesthesia with sedation in adults.
  • To assess audiological outcomes and patient experience with this approach.
  • To establish BiCI under LA as a potential alternative for hearing rehabilitation.

Main Methods:

  • Retrospective chart review of adult patients undergoing simultaneous BiCI under LA with sedation (2018-2024).
  • Assessment of clinical, surgical, audiological, and patient-reported data.
  • Evaluation of feasibility through complication rates, recovery, and patient feedback.

Main Results:

  • Six adult patients underwent simultaneous BiCI under LA with sedation without intraoperative complications.
  • All patients experienced uneventful recovery, with no reported dizziness, nausea, or vomiting.
  • Significant improvements in pure tone audiometry, speech reception threshold, and word recognition scores were observed, with positive patient experiences.

Conclusions:

  • Simultaneous bilateral cochlear implantation under local anesthesia with sedation is achievable and safe in adults.
  • This approach offers a potential alternative to general anesthesia, optimizing hearing rehabilitation.
  • A multidisciplinary approach is key to successful implementation of this technique.