A Peri-operative audit of the paediatric cochlear implantation programme at the Singapore General Hospital

Abstract

Introduction: Paediatric cochlear implantation has become an established procedure for treating irreversible hearing loss. The aim of this survey was to review the peri-operative anaesthetic management of this programme since its inception. Methods: We conducted a retrospective clinical audit of 184 paediatric (age <12) cochlear implantation cases by reviewing clinical records. The surgery was performed by the same surgeon at the Singapore General Hospital (SGH) from 1997 to 2010. Results: A total of 184 procedures (including five bilateral cases) were performed on 173 patients. The average age (mean [standard deviation, range]) at the time of surgery was 3.7 (±2.6, 0.7-11) years. The mean duration of the unilateral and bilateral implantation procedures were 3.2 (±1.0, 1.2-6.5) hours and 4.7 (±0.8, 4-6) hours respectively. Inhalational anaesthesia (66.3%) was the most popular choice for induction. 15 (8.1%) patients required additional analgesia in the post-anaesthetic care unit. In the ward, 14 patients (7.6%) required stronger analgesia in addition to paracetamol. Peak paracetamol requirement (22.9 [±16.6 ] mg/kg) was on the first postoperative day. Nausea and vomiting was reported in 19 (10.3%) procedures. The correlation between increasing age and post-operative nausea and vomiting was statistically significant (p<0.05) as was the association between age and analgesic requirements. The average duration of hospital stay was 3.2 (±1.0, 1-6) days. Mean age at time of surgery as well as duration of unilateral implantation procedures decreased over time. A trend towards same day admission (SDA) was also noted. Conclusion: Cochlear implantation in paediatric patients is a relatively safe procedure involving few complications.