title: Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries?
abstract: BACKGROUND
  Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs), there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery.
  
  
  METHODS
  A 60-year-old female with a permanent St. Jude's spinal cord stimulator (SCS) presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer's representative was contacted preoperative. Both surgeries proceeded uneventfully.
  
  
  CONCLUSIONS
  The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe.
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, JHS Hospital of Cook County, Chicago, IL, USA; Ghaly Neurosurgical Associates, Aurora, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA.
authors.forename: Ramsis F
authors.initials: RF
authors.lastname: Ghaly
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Tverdohleb
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Candido
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA.
authors.forename: Nebojsa Nick
authors.initials: NN
authors.lastname: Knezevic
keywords: Guidelines; neuromodulation; safety; spinal cord stimulator