Assessment of Anesthetic Modalities in Otologic Surgery

Otologic surgery has specific anesthetic requirements such as avoiding nitrous oxide and allowing facial nerve monitoring, but lacks clear criteria for an optimal anesthetic regimen, often relying on anesthesiologist preference.

This study is a retrospective review of 600 primary cochlear implant surgeries and anesthetic variables.

This study was conducted in a tertiary academic medical center.

Univariate, multivariate, and cluster analyses of anesthetic regimen association with clinical metrics of postoperative recovery.

Among 600 cochlear implant surgeries, anesthesia regimens included balanced (combination of gas and intravenous agents) (84.3%), gas alone (13.5%), and total intravenous anesthesia (TIVA) (2.2%). By univariate analysis, emergence from anesthesia was shortest with TIVA (11.9 ± 4.6 minutes) and longest with gas (14.2 ± 5.3 minutes), although not reaching statistical significance. Univariate analyses also failed to show a significant correlation between anesthesia regimen and phase I recovery or phase II duration. Multivariate regression indicated significantly shorter emergence times with TIVA compared with gas alone (coeff: -5.29, P = 0.0027). Cluster analysis identified 3 groups based on relative remifentanil and gas usage. Patients in cluster 1 (low gas and high remifentanil) had significantly longer emergence times than those in clusters 2 (low gas, low remifentanil: 16.26 ± 5.96 vs 13.39 ± 5.30 minutes; P = 0.001) and 3 (high gas, low remifentanil: 16.26 ± 5.96 vs 13.47 ± 5.48 minutes; P = 0.0069). Cluster 1 also had longer phase 1 recovery times compared with clusters 2 (65.33 ± 28.87 vs 54.33 ± 25.36 minutes; P = 0.0085) and 3 (65.33 ± 28.87 vs 56.38 ± 20.81 minutes; P = 0.0365).

TIVA anesthetic regimen is associated with shorter emergence time than gas alone, although the difference in time is small. Balanced regimens are most used among anesthesiologists, and limiting remifentanil dosage may shorten emergence and recovery times.