title: Conscious sedation and local anesthesia for patients undergoing neurotologic and complex otologic procedures.
abstract: OBJECTIVE
  Is conscious sedation an effective, safe, and efficient anesthetic choice in patients undergoing select neurotologic and otologic procedures?
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Six patients underwent eight neurotologic procedures including cerebrospinal fluid leak and encephalocele repair, and primary and revision cochlear implant surgery. Patients were deemed poor candidates for general anesthesia secondary to medical comorbidities. These were compared to 11 control patients who underwent same procedures under general anesthesia with intubation.
  
  
  METHODS
  Dexmedetomidine infusion was utilized as the primary agent for conscious sedation in this high-risk patient population because, unlike other commonly used sedatives, it preserves normal respirations while providing adequate analgesia.
  
  
  METHODS
  Preoperative Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) scores were calculated for the study group. We measured total anesthesia, and perioperative and recovery times. Cost of anesthetic agents was considered and any adverse effects were noted. Patient satisfaction with the operative experience was assessed with telephone surveys.
  
  
  RESULTS
  P-POSSUM scores were high for the study group. Postoperative anesthesia was shorter for the study patients undergoing conscious sedation. Difference in cost of anesthetic agents was negligible. The adverse effects were few and as expected for the type of procedure. Patients reported satisfaction and comfort with their operative experience.
  
  
  CONCLUSIONS
  Select neurotologic and otologic procedures can be safely, effectively, and efficiently performed under conscious sedation with dexmedetomidine infusion as the primary anesthetic choice for patients who are deemed poor medical candidates for general endotracheal anesthesia.
authors.affiliation: *Departments of Otolaryngology and †Anesthesiology, New York University Langone Medical Center, New York, New York, U.S.A.
authors.forename: Maja
authors.initials: M
authors.lastname: Svrakic
authors.forename: Aron
authors.initials: A
authors.lastname: Pollack
authors.forename: T Kate
authors.initials: TK
authors.lastname: Huncke
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Roland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D065634:Cerebrospinal Fluid Leak / Q000601:surgery; D016292:Procedural Sedation; D004677:Encephalocele / Q000601:surgery; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013506:Otologic Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives