Increased Propofol Sensitivity Associated With Hearing Loss in Patients Undergoing Vestibular Schwannoma Surgery: A Retrospective Study

Background: Propofol is widely used in neurosurgery, with its dosage typically based on patient weight and variability. While factors like age, sex, and cognitive function are known to influence propofol requirements, the impact of preoperative hearing function remains underexplored. This study investigates the relationship between hearing loss and propofol sensitivity in vestibular schwannoma surgery patients. Methods: This retrospective study analyzed 475 patients who underwent vestibular schwannoma resection between May 12, 2020, and February 28, 2024. Total intravenous anesthesia (TIVA) with propofol and remifentanil was used, maintaining BIS values between 40 and 60. Hearing impairment was defined as a pure tone average (PTA) ≥20 dB. Multivariable linear regression was used to assess the relationship between preoperative hearing function and propofol requirements. Results: The hearing-impaired group was older (51.7±10.5 vs. 42.9±10.5 y, P <0.001) and required lower median (IQR) propofol doses (96.7 [85.2 to 115.2] vs. 109.0 [91.4 to 126.9] μg·kg −1 ·min −1 , 95% CI: 5.511-15.016, P <0.001). In unadjusted analysis, hearing loss (PTA ≥20 dB) was associated with reduced propofol requirements (OR: −10.4, P <0.001). This association remained significant in multivariable analysis adjusting for age, sex, ASA, BMI, and anesthesia provider (ORadj: −5.0; 95% CI: −9.8 to −0.2; P =0.040). Conclusion: Hearing loss is associated with increased propofol sensitivity in vestibular schwannoma surgery, highlighting its potential relevance in anesthesia management.