Multidisciplinary aspects of pediatric cochlear implantation: anesthesiological considerations

Early cochlear implantation during the critical period of neuroplasticity leads to better auditory and language outcomes but presents unique anesthetic challenges in infants. This study retrospectively examined anesthesia-related events throughout the full diagnostic and surgical process over a 10-year period, focusing on pediatic population undervent cochlear implantation - especially under the age of 18 month.

Data from 175 children under age 3 were analized who received cochlear implants between 2014 and 2024. Anesthesia-related events during audiological tests (BERA/ASSR), imaging (CT/MRI), and surgery were recorded. Collected variables were demographics, comorbidities, ASA and Mallampati scores, anesthetic techniques, procedure durations, complications, and ICU admissions. A subgroup analysis was conducted for patients implanted before 18 months.

Of the 175 patients, 35 (20.2%) received implants before 18 months and 8 (4.6%) before 12 months. Anesthesia-related complications occurred in 14 cases (8.1%) in the study population, with laryngospasm during extubation being the most frequent (n = 8); all resolved without reintubation. Difficult intubation was noted in 3 patients, mainly those with craniofacial anomalies. Four children required postoperative ICU care. No complications were observed during diagnostic procedures. No significant association was found between complication rates and age, ASA status, or Mallampati score.

Cochlear implantation, even in infants under one year, is safe with appropriate anesthesia and experienced teams. Complications were rare and manageable. Recognizing anesthesia risks helps optimize care and reassure parents, supporting timely intervention within the neuroplastic window.