Spinal Cord Stimulator Removal
|Lines and access||
1 PIV, +/- A-line
Standard, 5-lead EKG
|Primary anesthetic considerations|
TIVA for neuromonitoring, prone positioning
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.
Paddle leads are larger and usually anchored to the spinal column under a small piece of bone.
|Neurologic||Careful neurological exam to document preexisting deficits|
|Cardiovascular||Chronic pain can lead to decreased physical activity & decreased cardiovascular reserve.|
|Gastrointestinal||Chronic opioid use may lead to decrease gastric emptying & decreased GI motility|
|Hematologic||Multilevel laminectomy may be needed. Active type & screen.|
Labs and studies
Operating room setup
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
Monitoring and access
1 good IV
Induction and airway management
General endotracheal anesthesia.
Maintenance and surgical considerations
TIVA for neuromonitoring
Spinal cord injury
|Variant 1||Variant 2|