Propofol with remifentanil provides good operative conditions for pediatric cochlear implant
(CI); however, large doses of remifentanil usually result in postoperative hyperalgesia and
increase postoperative pain. Local anesthesia (LA) is commonly used as an adjunct to general
anesthesia in children; however, otologists are usually reluctant in the use of LA as it can
cause abolishment of the electrical stapedial reflex threshold (ESRT).