Spinal cord stimulator & cardiac surgery

[proman]

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Hi I was wondering if someone could give some advice about my case tomorrow:

69 year old male with severe mitral regurg for MVR with cardiopulmonary bypass tomorrow. He apparently has a spinal cord stimulator (as shown on a CT scan). I don't have access to the rest of his medical history, and I'll meet him tomorrow morning.

My questions to you:

1) I assume the stimulator needs to be turned off for the case since we will use electrocautery. Is this correct?

2) Where can the grounding pad go? The standard approach for pacemakers/ICDs is to put the grounding pad far away from the device. The standard location for the grounding pads are the posterior/lateral thighs. Is this ok?

3) Any other advice for this patient?

Thanks.

 

[drf]

When I put them in I'll bovie on the lead itself as I dissect down to some fascia before anchoring. My sense is it should be fine with no restrictions. Probably don't put the pad over the battery though.

 

[ParaVert]

All 3 SCS makers advise against using a Bovie. Bipolar would be much better. If forced to use cautery, place the pad as far away from the battery as possible - maybe an upper extremity. That would keep the path of current away from the battery. System should be tested by a rep before discharge home. Risk of frying the battery is not small.

 

[proman]

Thanks for the responses. The patient turns off the stimulator (didn't realize they could) and that's all we did special. I'll pass it on to the surgeons to get in touch with the rep before discharging.

 

[ultm8frisbee]

When I put them in I'll bovie on the lead itself as I dissect down to some fascia before anchoring. My sense is it should be fine with no restrictions. Probably don't put the pad over the battery though.

Really, with monopolar cautery? I hope you've at least removed the touhy as this could lead to current being conducted directly to the epidural space, leading to potential nerve damage. Are we assuming the lead is completely insulated and non-conductive?

 

[drf]

Really, with monopolar cautery? I hope you've at least removed the touhy as this could lead to current being conducted directly to the epidural space, leading to potential nerve damage. Are we assuming the lead is completely insulated and non-conductive?

Tuohy out, of course. Medtronic rep in the room says its fine and all his surgeons do it this way. Monopolar. No probs.

I used to put in the anchor stitches before removing the tuohy to protect the lead. However getting a great dissection down to fascia is more difficult this way and I have to use something sharp and no bovie. So I switched to taking the tuohy out, bovie down to fascia, then anchoring.

 

[Jcm800]

Tuohy out, of course. Medtronic rep in the room says its fine and all his surgeons do it this way. Monopolar. No probs.

I used to put in the anchor stitches before removing the tuohy to protect the lead. However getting a great dissection down to fascia is more difficult this way and I have to use something sharp and no bovie. So I switched to taking the tuohy out, bovie down to fascia, then anchoring.

I bovine monopolar all the time. I bovie the sheet out of the area. No problems. I have not used bi polar in 5 years. I also cut down BEFORE the needle placement, which makes it much easier and quicker...

 

[facets]

I bovine monopolar all the time

Holy crap docshark, u are doing cows? Business must be slow

 

[Jcm800]

I bovine monopolar all the time

Holy crap docshark, u are doing cows? Business must be slow

If you saw my patients, this would not be a typo...

 

[PMR 4 MSK]

If you saw my patients, this would not be a typo...

We grow 'em big in the midwest 😱