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Introduction. Cochlear implantation is a recognized treatment method for patients with severe and deep neurosensory hearing loss. To adjust the parameters of the speech processor of a cochlear implant (CI), the implementation of subjective techniques is not always possible, especially for younger patients. A good starting point for determining patient comfort levels during the initial connection of a speech processor is the intraoperatively obtained data of objective methods, one of which is the registration of an electrically induced stapedial reflex (EISR). Due to the marked effect of general anesthesia on the results of testing of CI and the lack of a universal anesthesiological protocol for this surgical intervention, the purpose of the study is to study the effectiveness of using extended intraoperative monitoring during testing of CI. Material and methods. The study included two groups, each consisting of 26 patients aged from 1 year to 15 years with a diagnosis of chronic sensorineural hearing loss. All children were installed CI delivered by company Med El (Austria). In the 1st group, data from medical records were analyzed retrospectively (anesthetic patient card and ESRT threshold values registration card during anesthesia and standard anesthesia monitoring volume). In the 2nd group of patients, intraoperative monitoring of anesthesia was extended by continuous evaluation of EEG (BIS-index) and indices of the degree of myoplegia. CI testing in this group was carried out in the recovery phase of neuro-muscular conductivity (4 TOF responses) and with BIS-index values from 60 to 80, which corresponded to sedation during drug sleep. Results. In the course of the work done in two groups of patients, the average values of intermediate points of the ESRT were analyzed, a comparative assessment of hemodynamic parameters at the main stages of the operation was carried out, and the optimal values of the minimum alveolar concentration of sevoflurane anesthetic and BIS index were determined for timely registration of the movement of stapedial muscle by the surgeon.

For the time present, the cochlear implantation is a widely used method of the treatment of deafness and severe hearing impairment. The operation is time-consuming and requires a long stay of the child in the hospital. The placement of the cochlear implant (CI) is executed under general anesthesia through transosseous access. The executive work of the surgical and anesthetic teams is an integral part of the successful implementation of intraoperative CI testing, on the base of results of which, in the postoperative period, there will be carried out the initial adjustment of the speech processor. An anesthesiologist should create conditions that facilitate the use of nerve stimulators in the intraoperative period and in a timely manner prevent such common postoperative complications as nausea, vomiting, and dizziness. This article provides a review of the literature of domestic and foreign authors on the issues arising in anesthesiologists during the implementation of cochlear implantations and the ways of their solutions. It is considered what difficulties can arise during the installation and initial adjustment of CI, as well as what anesthesia complications are most frequent in operations of this type. After studying the results of the work of different authors, the initial adjustment of the CI in the anesthetic management under the control of BIS and TOF monitoring was concluded to be performed at a higher level, and the timely and targeted administration of various drugs, at certain stages of anesthesia, contributed to the decline of the complications rate in the postoperative period.

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Клинические наблюдения Relevance. The hypoplastic left-heart syndrome at congenital heart disease has frequency of 261 cases out of 10,000 newborns. Children with hypoplastic left-heart syndrome can have comorbid congenital anomalies and acquired diseases that require treatment and are associated with high mortality risk. Description of a clinical case. Female patient, 6 years 4 months, with the hypoplastic left-heart syndrome was admitted to our hospital with the diagnosis «Sensorineural hearing loss, speech delay» for performing of cochlear implantation. The council of physicians was convoked before the surgery to coordinate patient management. Members of surgical, anesthesiology, laboratory and instrumental examination departments were involved into preoperative assessment and planning due to the high level of surgical and anesthetic risk. The patient was dismissed from hospital on the 10 th day after cochlear implantation. The patient has undergone the course of auditory-verbal therapy a month after. The child was dismissed wit state improvement. Conclusion. The example of successfully performed surgery in the patient with hypoplastic left-heart syndrome and such severe comorbid pathology as sensorineural hearing loss is presented. Complete physical examination of the child in preoperative period and adequate preparation for the surgery were the key factors for patient successful management and further rehabilitation.