Faculty Bibliography

OBJECTIVES/HYPOTHESIS: Cochlear implantation (CI) is effective in the treatment of childhood sensorineural hearing loss and is associated with minimal surgical complications. We investigated the incidence of anesthetic complications in young patients undergoing general anesthesia for CI. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review of 123 patients younger than 18 years, who underwent CI between 2007 and 2008, was conducted for identification of intra- and postoperative anesthesia-related complications. The relation of collected variable to the complication events was analyzed using logistic regression. RESULTS: Of the 123 CI procedures, eight patients had nine anesthesia-related complications, yielding a complication rate of 6.5% and included the following: postoperative wheezing/stridor (5 cases), laryngospasm (3 cases), and emesis during inhalational induction (1 case). Divided by age group, 12 patients were <12 months with one complication (8%), 18 patients were between 1 and 2 years with one complication (5.6%), 35 patients were between 2 and 5 years with one complication (3%), 39 patients were between 5 and 12 years with five complications (13%), and 19 patients were older than 12 years with no complication (0%). Logistic regression failed to identify a significant association of any collected variable(s) with the observed complications. The incidence of complications is similar to that previously reported in elderly patients (4.3%) (Pearson chi(2) , P = .523). CONCLUSIONS: General anesthesia is well tolerated by pediatric patients undergoing CI, even under 1 year of age. Significant perioperative complications are primarily respiratory, are usually free of long-term sequelae, and occur with an incidence similar to other reported age groups

INTRODUCTION: The mechanisms by which reduced preoperative glomerular filtration rate (eGFR) predispose patients to adverse postoperative outcomes are not well defined1. Furthermore, the effects of medications commonly prescribed to slow the progression of chronic kidney disease (CKD) are unclear in the perioperative period2,3,4. The goal of this study was to evaluate these medications on the following postoperative outcomes: acute kidney injury (AKI), myocardial infarction (MI), infection, venous thromboembolism (VTE), and readmission within 30 days. We hypothesized that patients with CKD who were on an angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), diuretic, statin, beta blocker, insulin or calcium channel blocker (CCB) preoperatively would have lower rates of surgical complications than CKD patients who were not on these medications. METHODS: With institutional review board approval, patients with reduced eGFR (<60 ml/min/1.73m2) and a list of their prescribed medications at the time of surgery were isolated from a database of adult patients who underwent elective surgery at a single large academic institution between June 2011 and July 2013. Patients were identified as either taking or not taking ACE-Is, ARBs, diuretics, statins, beta blockers, insulin, or CCBs. Propensity score matching was done by first performing logistic regression with each medication individually as the dependent treatment variable. Preoperative medical comorbidities, age, and gender were used as covariates that may influence preoperative medication use. One-to-one matching without replacement was performed based on the derived propensity scores. The outcomes of interest were AKI, MI, infection, VTE, and readmission within 30 days, and were analyzed by logistic regression. RESULTS: After applying exclusion criteria, 2865 patients remained. Matching resulted in between approximately 250 and 1100 pairs depending on the medication. After matching, there was no apparent association between the preoperative medications explored and the outcomes of interest, except for a statistically significant association between beta blocker use and readmission within 30 days (Table 1). CONCLUSIONS: This study suggests that common medications taken by patients with CKD preoperatively do not have a significant effect on the development of postoperative complications. Furthermore, our results do not support discontinuation of preexisting medications or the addition of any of these agents prior to surgery. Identifying factors modifiable by medication management or lifestyle interventions is a critical step toward developing protocols to enhance patient safety and postoperative recovery in the CKD population. Further investigation is needed to determine the effect of other factors such as surgical severity, smoking status and volume status on postoperative outcomes to define optimal protocols for CKD patients. (Table Presented)

OBJECTIVES/HYPOTHESIS: Most elderly patients with severe to profound hearing loss are not being referred for cochlear implantation (CI), the only intervention to significantly improve hearing and quality of life in this population. Possible concern over the risks of anesthetic in the elderly may be one of the foremost concerns. The authors investigated whether advanced age is a risk factor when undergoing general anesthesia for cochlear implantation. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review was conducted at a tertiary academic referral center of 70 patients older than 70 years, who underwent CI with general anesthesia between 1984 and 2007, and for whom anesthesia records were available. Patients were divided into anesthetic risk group A (American Society of Anesthesiologist classification [ASA] I/II) and B (ASA III/IV). Intraoperative and postoperative anesthesia-related complications were identified. RESULTS: Of the 70 patients, 44 were in group A and 26 were in group B, both with a mean age of 77. Four patients, one from group A and three from group B, required intraoperative pressors for blood pressure support. There were no anesthesia-related complications in group A, but there were three (12% of group B and 4% overall) in group B: delayed extubation, postoperative congestive heart failure, and urinary retention. There was no long-term morbidity or mortality. CONCLUSIONS: General anesthesia is well tolerated by elderly patients undergoing cochlear implantation. Preexisting medical condition of the patient as defined by ASA is a better predictor of intraoperative and postoperative complication than age alone

Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field.