29 children. Age - 18 months to 11 yrs. All children had bilateral severe to profound sensorineural hearing loss. Children with compromised neural/cochlear anatomy were excluded. Patients were maintained on an infusion of Fentanyl @ 0.3-0.6 ugm/kg/hr and Propofol @ 4-8 mg/kg/hr intraoperatively. Intraoperative measurements were done after performing the train of four test on the adductor pollicis muscle Results It was observed that ESRT was unaffected by intravenous anaesthesia. Electrical impedance and ECAP were not affected by any technique of anaesthesia. Conclusion Intravenous anaesthesia has little or no effect on the intraoperative auditory thresholds and is therefore recommended for determining these thresholds during cochlear implant surgery.

A 28-year-old female with a history of multidrug-resistant tuberculosis presented with bilateral severe to profound sensorineural hearing loss. On evaluation, she was found to be a suitable candidate for cochlear implantation. However, she was clinically unfit to undergo the surgery under general anaesthesia. After counselling the patient, the decision to undertake the procedure under local anaesthesia was made. The procedure took 105 min and was uneventful. The patient was discharged the next day Conclusion: In the hands of an experienced surgeon and anaesthesiology team, bilateral cochlear implantation is possible under local anaesthesia. Patient motivation and cooperation are extremely important for the procedure to be done under local anaesthesia. This is an option for patients needing cochlear implantation who are medically unfit for general anaesthesia.

The data in the published literature on the use of dexmedetomidine in various dosages during extubation from India is modest. We have compared the effectiveness of intravenous dexmedetomidine 0.5 µg/Kg body weight and 0.75 µg/Kg body weight during endotracheal extubation. Seventy-four patients aged more than 18 years posted for elective surgery under general anaesthesia were included in this randomised double- blind controlled study. Group D1 and Group D2 patients received 0.5 µg/Kg and 0.75 µg/Kg body weight intravenous dexmedetomidine respectively. The primary outcome measures were to compare haemodynamic parameters, whereas secondary outcome measures were to compare extubation quality, and post-extubation sedation. The mean heart rate at reversal, and after endotracheal extubation was considerably elevated in group D1 as compared to D2. The mean systolic blood pressure, diastolic blood pressure and mean arterial pressure after endotracheal extubation were considerably elevated in group D1 as compared to D2. The mean respiratory rate at reversal, and after endotracheal extubation were considerably elevated in Group D1 as compared to Group D2. The mean sedation score after endotracheal extubation was considerably elevated in Group D2 as compared to Group D1. The haemodynamic parameters were better in Group of patients who received intravenous dexmedetomidine 0.75 µg/Kg body weight as compared to Group of patients who received dexmedetomidine 0.50 µg/Kg during endotracheal extubation.

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