When to do trial after emergency surgery?

[Rocuronium18]

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Hi all,

Just wondering if you have guidance on when it is safe to offer a SCS trial for a patient after they’ve had emergency/elective surgery (unrelated to the reason for SCS trial). We have a patient who has been on our waitlist for SCS trial, but just had an emergency carotid endarterectomy. We were thinking we should wait at least eight weeks, but is there any formal guidance on this?

 

[Orin]

Atleast 3 months as they were likely having a stroke if they had an emergency CEA

 

[Agast]

I would require updated clearance for when they are allowed to stop their plavix post CEA

Also trial leads apparently are not cleared for MRI compatibility, if they need an urgent MRI brain you have to pull them out.

 

[Orin]

Okay, so at least 3 months is probably generous:

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary

www.jwatch.org

"
Compared with patients who never experienced strokes, those who had prior strokes had higher risk for major adverse cardiovascular events (MACE: a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular-related death):

• Stroke within 3 months before surgery: odds ratio, 14.2
• Stroke between 3 and 6 months prior: OR, 4.9
• Stroke between 6 and 12 months prior: OR, 3.0
• Stroke ≥12 months prior: OR, 2.5

A similar pattern in risk was seen for 30-day mortality. Risk for MACE and all-cause mortality leveled off at 9 months."

 

[Agast]

I would also clarify what the status of their other carotid artery is.

 

[Ducttape]

Hi all,

Just wondering if you have guidance on when it is safe to offer a SCS trial for a patient after they’ve had emergency/elective surgery (unrelated to the reason for SCS trial). We have a patient who has been on our waitlist for SCS trial, but just had an emergency carotid endarterectomy. We were thinking we should wait at least eight weeks, but is there any formal guidance on this?

would want them to be able to hold anticoagulation for duration of the trial and pretrial period.

would want clearance by neurosurg or vascular surg.


my guess is that the patient has a lot of other things on his mind at the moment...

 

[Rocuronium18]

Agree, this patient has unique challenges (perioperative stroke and cardiac event risk) but I was wondering also for patients who are undergoing elective surgery for other reasons and guidance on them