Intrathecal Pump: An Abrupt Intermittent Pump Failure.
METHODS
Intrathecal baclofen is an established method of treating spasticity. However, this therapy is not without significant morbidity and mortality. The known morbidity associated with intrathecal pumps includes death, infection, and sepsis including central nervous system infection, accidental overdose, wrong drug administration as well as technical failures such as pump or battery failure, catheter migration or catheter breakage. Medtronic has issued a number of advisories, most recently in June 2013, regarding the safety of the Medtronic SynchroMed II intrathecal pumps.


METHODS
Sixty-four months post insertion of a SynchroMed II, model 8637; our patient was reviewed as a matter of urgency by our team, as he was complaining of worsening spasticity and pain. The device was interrogated and this indicated a motor stall at the time of interrogation. The interrogation also revealed that this was the third period of motor stall in the preceding three days. According to the patient, and consistent with our interrogation, the device had been alarming intermittently for the previous three days.


METHODS
He was commenced on oral baclofen overnight, which gave some improvement to his symptoms. A replacement intrathecal pump was inserted the following day. This provided the patient with his usual level of relief. The product Engineering Department at Medtronic reviewed the original pump.


RESULTS
The patient's new intrathecal pump has been functioning uneventfully since its replacement and he continues to receive good symptom relief from his new pump. Internal inspection of the pump by the Engineering Department at Medtronic revealed corrosion of the motor gearbox.


CONCLUSIONS
Our unit continues to retain a high level of vigilance when dealing with potential complications of intrathecal pump therapy. Supplemental oral baclofen may have a role in this setting.
Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland.
John
J
Riordan
Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland.
Paul
P
Murphy
D000328:Adult; D001418:Baclofen / Q000009:adverse effects*; D004868:Equipment Failure; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects*; D008297:Male; D009125:Muscle Relaxants, Central; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy*; D010146:Pain / Q000150:complications / Q000188:drug therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen
Baclofen; case report; intrathecal drug delivery; safety; withdrawal