Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists.
OBJECTIVE
Patients with implanted electrical devices (IEDs) are vulnerable to electromagnetic interference (EMI) from electrical equipment used in the perioperative environment. As the indications for non-cardiac IEDs increase, so too does the likelihood of anesthesiologists encountering such patients who present for surgery. This article reviews the important anesthetic considerations for patients with implanted non-cardiac electrical devices.


METHODS
We searched Medline (1980 to December 2008) and Embase (1980 to December 2008) and reviewed all relevant manuscripts regarding non-cardiac IEDs and anesthesia.


RESULTS
There are numerous non-cardiac IEDs currently in use, including deep brain stimulators, vagal nerve stimulators, gastric stimulators, phrenic nerve stimulators, sacral nerve stimulators, and bone stimulators. A key goal in the perioperative management of these patients is to reduce the risk of adverse events resulting from device interactions with electrocautery, external emergency cardiac defibrillation, peripheral nerve stimulation, neuraxial anesthesia, and magnetic resonance imaging. We offer a general management strategy for patients with IEDs presenting for surgery.


CONCLUSIONS
In the absence of available anesthesia management guidelines regarding non-cardiac IEDs in the perioperative setting, anesthesiologists should appreciate the basic principles pertaining to IEDs to ensure appropriate risk reduction strategies in order to enhance patient safety.
Venkatraghavan
Lashmi
L
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada. Lashmi.venkatraghavan@uhn.on.ca
Chinnapa
Vinod
V
Peng
Philip
P
Brull
Richard
R
D000758:Anesthesia / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D004567:Electrodes, Implanted / Q000009:adverse effects; D004574:Electromagnetic Fields / Q000009:adverse effects; D004869:Equipment Safety / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D019736:Prostheses and Implants / Q000009:adverse effects; D040242:Risk Reduction Behavior