Spinal Cord Stimulator Removal
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
1 PIV, +/- A-line |
| Monitors |
Standard, 5-lead EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
TIVA for neuromonitoring, prone positioning |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Neuromodulatory techniques such as spinal cord stimulation (SCS) are playing an increasing role in chronic pain management. The SCS leads are placed in the dorsal epidural space, either surgically or percutaneously, and are connected to a subcutaneously implanted programmable pulse generator.
They are most commonly removed for inadequate pain relief, but can also be removed for lead migration, device damage, infection, etc.
Overview
Indications
Surgical procedure
Paddle leads are larger and usually anchored to the spinal column under a small piece of bone.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Prone positioning |
| Neurologic | Careful neurological exam to document preexisting deficits |
| Cardiovascular | Chronic pain can lead to decreased physical activity & decreased cardiovascular reserve. |
| Pulmonary | |
| Gastrointestinal | Chronic opioid use may lead to decrease gastric emptying & decreased GI motility |
| Hematologic | Multilevel laminectomy may be needed. Active type & screen. |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
CBC
Operating room setup
TIVA
Patient preparation and premedication
Chronic opioid use may lead to difficulty with pain control postoperatively. Consider multimodal treatment & acute pain consult.
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
1 good IV
+/- A-line
Induction and airway management
General endotracheal anesthesia.
Positioning
Prone
Maintenance and surgical considerations
TIVA for neuromonitoring
Emergence
Postoperative management
Disposition
PACU
Pain management
Potential complications
Epidural hematoma
Spinal cord injury
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |