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Vestibular Neurectomy Medication

  • Author: Jayita Poduval, MS, MBBS, DNB(ENT), DORL; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Jan 17, 2014
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Preoperative sedation and premedication is given, usually clonidine, metoclopramide, and midazolam and intravenous ceftriaxone. Mannitol is given throughout the surgery, and dexamethasone is given for 4 days. Furosemide is added when necessary.

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Alpha 2-adrenergic Agonist Agents

Class Summary

These agents may reduce sympathetic outflow, which may produce a reduction in muscle tone.

Clonidine (Catapres, Nexiclon, Kapvay, Duracion)

 

Clonidine stimulates alpha2-adrenoreceptors in the brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow.

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Prokinetic Agents

Class Summary

Medications that increase gastric motility (eg, Reglan) may be administered. Gastric motility also may be increased if the patient eats small, frequent meals and sleeps with his/her head elevated.

Metoclopramide (Reglan, Metozolv)

 

The antiemetic effect of metoclopramide appears to be due to its ability to block dopamine receptors in the chemoreceptor trigger zone (CTZ) of the central nervous system (CNS). This agent also enhances gastrointestinal motility and accelerates gastric emptying time.

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Anxiolytics, Benzodiazepines

Class Summary

In the operating room, intravenous (IV) administration of a small dose of midazolam before arterial line insertion can reduce anxiety, tachycardia, and hypertension.

Midazolam

 

Midazolam is a short-acting benzodiazepine with a rapid onset of action.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

 

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity. It arrests bacterial growth by binding to one or more penicillin-binding proteins. Initiate treatment with a high dose for adequate treatment of potential penicillin-resistant pneumococcal infection. Administer 2 g intravenously for 24 hours; begin at the time of surgery and continue for the duration of the intravenous infusion, usually for 5 days.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body’s immune response to diverse stimuli.

Dexamethasone (Baycadron)

 

Dexamethasone has many pharmacologic benefits but also significant adverse effects. It stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentrations, and inhibits prostaglandin and proinflammatory cytokines. Administer 4 mg every 8 hours for 4 days.

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Diuretics, Loop

Class Summary

These agents should be reserved for well-hydrated patients with insufficient diuresis.

Furosemide (Lasix)

 

Furosemide increases the excretion of water by interfering with the chloride-binding cotransport system. This, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and the distal renal tubule.

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Diuretics, Osmotic Agents

Class Summary

These agents increase osmolarity of glomerular filtrate and induce diuresis. They hinder tubular reabsorption of water, causing sodium and chloride excretion to increase.

Mannitol (Osmitrol)

 

Mannitol is an osmotic diuretic that lowers blood viscosity and produces cerebral vasoconstriction with normal CBF. A decrease in ICP occurs subsequent to a decrease in cerebral blood volume (CBV). Administer 0.5 mg/kg intravenously.

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Contributor Information and Disclosures
Author

Jayita Poduval, MS, MBBS, DNB(ENT), DORL Assistant Professor, Department of ENT, Pondicherry Institute of Medical Sciences, India

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

References
  1. Endolymphatic Sac Shunt, Labyrinthectomy and Vestibular Nerve Section in Meniere’s Disease. Meniere’s Disease. Otolaryngological Clinics of North America. October 2010. 43:5.

  2. Chapter 35-Middle cranial fossa-vestibular neurectomy; Chapter 36-Retrolabyrinthine and retrosigmoid vestibular neurectomy. Otologic Surgery-Brackmann, Shelton and Arriaga. 3rd Edn.

  3. Fisch U, Mattox D. Microsurgery of the Skull Base. New York: Thieme; 1988.

  4. Anatomy and Ultrastructure of the Human Ear. Basic Sciences. Scott-Brown’s Otolaryngology. 6th. 1:

  5. Silverstein H, Nichols ML, Rosenberg S, Hoffer M, Norrell H. Combined retrolabyrinthine-retrosigmoid approach for improved exposure of the posterior fossa without cerebellar retraction. Skull Base Surg. 1995. 5(3):177-80. [Medline].

  6. Li CS, Lai JT. Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière's disease: an interdisciplinary review. Acta Neurochir (Wien). 2008 Jul. 150(7):655-61; discussion 661. [Medline].

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