Recommendations for anesthetic management for intraoperative neuromodulation cases

Area of Science:

• Anesthesiology
• Neurosurgery
• Pain Management

Background:

• Neuromodulation devices, including dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators (PNSs), and intrathecal pumps, are increasingly used for chronic pain management.
• Optimal perioperative anesthetic management for these devices is not well-defined, potentially impacting patient outcomes.

Purpose of the Study:

• To review current literature and present single-center experience regarding perioperative management for various neuromodulation implantations.
• To identify gaps in knowledge and advocate for further research into specific anesthetic guidelines for these procedures.

Main Methods:

• Literature review of existing studies on perioperative care for neuromodulation.
• Analysis of single-center experience with pre-operative, intra-operative, and post-operative management.
• Discussion of anesthetic considerations for DCS, DRG, PNS, and intrathecal pump placement.

Main Results:

• Pre-operative antibiotics are generally recommended, with discontinuation within 24 hours postoperatively.
• Monitored anesthesia care or general anesthesia with intra-operative neuromonitoring is suggested for DCS and DRG stimulation.
• Monitored anesthesia care is preferred for PNS and intrathecal pump implantation.

Conclusions:

• Current guidelines for anesthetic management during neuromodulation device implantation are limited.
• Further research is essential to establish comprehensive perioperative anesthetic guidelines for DCS, DRG stimulation, PNS, and intrathecal pumps.
• Standardized protocols could improve patient safety and procedural success rates.