Sedation is more Efficient than General Anesthesia for Stapes Surgery: A Single Center Experience

Background: Otosclerosis results in hearing loss caused by bony disease of the otic capsule. Treatment involves extremely delicate microsurgery: stapedectomy. Traditionally, stapes surgery was performed using general anesthesia to minimize patient movement. Recently, there has been an interest in intraoperative patient feedback regarding vestibular disturbances and hearing testing. There are no studies clarifying the optimal sedation protocol for these procedures. Methods: We undertook a retrospective chart review (n=52) and assessed differences in patient tolerance of the procedure, length of surgery, estimated blood loss, hemodynamic instability, and post-operative pain and/or nausea between patients who underwent general anaesthesia and those who underwent dexmedetomidine based sedation with local anaesthetic (LoMAC). Results: In addition to confirming that MAC using dexmedetomidine and local anesthetics is safe and well tolerated, thus allowing immediate perioperative neuro-otological feedback to the surgeon, our data also demonstrate a significantly shorter average length of surgery with MAC. Furthermore, we did not find differences regarding hemodynamic instability or post-operative pain medication requirements. Conclusion: Since cost of procedures is directly related to OR time, there may be financial benefit with MAC.