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Cutaneous electrosurgery in a patient with a deep brain stimulator
1Department of Dermatology, Loma Linda University Medical Center, Loma Linda, California, USA.
Summary
Electrosurgery can cause adverse effects in patients with deep brain stimulators (DBS). Using bipolar devices or deactivating the DBS can mitigate these risks during dermatologic surgery.
Area of Science:
- Neurosurgery
- Dermatology
- Biomedical Engineering
Background:
- Deep brain stimulators (DBS) are implanted devices managing movement disorders like Parkinson's disease.
- Electrosurgery poses potential risks to patients with implanted electrical devices, similar to cardiac devices.
Observation:
- A case report details electrosurgery use on a patient with essential tremor and a DBS during Mohs surgery.
- The patient experienced electrical shock with monopolar electrosurgery.
- No discomfort was reported with bipolar electrosurgery or when the DBS was deactivated.
Findings:
- Monopolar electrosurgery can induce adverse effects in patients with DBS.
- Bipolar electrosurgery and temporary deactivation of the DBS are safer alternatives.
- Proper placement of the dispersive plate is crucial for mitigating risks.
Implications:
- Dermatologic surgeons must exercise caution with patients who have CNS electrical devices.
- Awareness of potential electrosurgery complications is critical for patient safety.
- Implementing specific procedural modifications can reduce adverse events in this patient population.