Difference between revisions of "Spinal Cord Stimulator Removal"
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(Created page with "{{Infobox surgical procedure | anesthesia_type = General | airway = ETT | lines_access = 1 PIV | monitors = Standard, 5-lead EKG | considerations_preoperative = | considerations_intraoperative = TIVA for neuromonitoring, prone positioning | considerations_postoperative = }} 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...") |
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| Line 2: | Line 2: | ||
| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = 1 PIV | | lines_access = 1 PIV, +/- A-line | ||
| monitors = Standard, 5-lead EKG | | monitors = Standard, 5-lead EKG | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| Line 29: | Line 29: | ||
|- | |- | ||
|Airway | |Airway | ||
| | |Prone positioning | ||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | |Careful neurological exam to document preexisting deficits | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Chronic pain can lead to decreased physical activity & decreased cardiovascular reserve. | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| Line 41: | Line 41: | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | |Chronic opioid use may lead to decrease gastric emptying & decreased GI motility | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Multilevel laminectomy may be needed. Active type & screen. | ||
|- | |- | ||
|Renal | |Renal | ||
| Line 57: | Line 57: | ||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
CBC | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
TIVA | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
Chronic opioid use may lead to difficulty with pain control postoperatively. Consider multimodal treatment & acute pain consult. | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
| Line 68: | Line 71: | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
1 good IV | 1 good IV | ||
+/- A-line | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
| Line 88: | Line 93: | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Epidural hematoma | |||
Spinal cord injury | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Latest revision as of 17:51, 1 October 2022
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 |