Otosclerosis has a disabling character through progressive hearing reduction. The
etiopathogenetic process consists of osteodystrophy degeneration of the otic capsule,
leading to decreased mobility of the stapes bone of the middle ear and causing conductive
or mixed hearing loss. It is relatively common in ENT (ear, nose and throat) pathology,
generally affecting young adults with a 4:1 ratio between women and men. Treatment is
surgical by stapedotomy or stapedectomy and placement of a Teflon prosthesis designed to
restore the vibratory capacity of the ossicular complex of the middle ear. Anesthetic
management consists, depending on institutional custom, surgeon, or patient preference,
in general anesthesia or, relatively frequently, monitored anesthesia care alongside
local anesthesia. There is no specific regional anesthesia technique for middle ear
interventions because the ear exhibits heterogeneous sensory innervation containing
branches from the cervical plexus and cranial nerves V, VII, and X. Local anesthesia
consists of circular infiltration of the ear canal and association with an effective
sedation technique is indispensable for patient and operator comfort. The objectives of
sedation are:
An immobile operating field.
Minimal bleeding.
Hemodynamic and respiratory stability.
Reducing the risk of postoperative nausea and vomiting.
Patient comfort. The significant advantage of conscious sedation over general
anesthesia or deep sedation is the possibility of real-time feedback from the
patient in case of vertigo or for hearing testing after fitting the prosthesis. Deep
sedation may also produce an uncooperative patient with involuntary movements or
upper airway obstruction under conditions of problematic access to the cephalic
extremity that may compromise the operating field.
Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist that appeared in
clinical anesthetic practice relatively recently, with sedative effects, reduction of
required opioid doses, reduced frequency of delirium and agitation, perioperative
sympathicolysis, cardiovascular stabilizing impact and preservation of respiratory
function.
Remifentanil is a synthetic, potent, ultrashort-lived opioid used for postoperative
analgesia, sedation, or general anesthesia.
The objective of this study is to compare dexmedetomidine (continuous infusion) to
remifentanil (target-controlled infusion according to the Minto model) for monitored
anesthesia care of a cohort of patients with otosclerosis presenting for
stapedectomy/stapedotomy at the ENT Clinic - Cluj County Clinical Emergency Hospital.