The safe management of non-cardiac implantable electrical devices during surgery requires careful planning and knowledge of device-specific considerations. We continue our discussion from last week with actionable recommendations for each stage of perioperative care.

• Electrocautery poses significant risks including device reprogramming, thermal burns, and damage to neural tissue
• Turn off devices or set to safe surgery mode before using electrocautery
• Bipolar cautery is safer than monopolar; if monopolar is needed, use lowest power setting
• Place grounding pads to minimize current through the device generator
• Somatosensory evoked potentials (SSEPs) are relatively safe while motor evoked potentials (MEPs) should be avoided
• Newer devices may be MRI conditional but require specific protocols including device interrogation
• Regional anesthesia should use ultrasound guidance rather than nerve stimulation techniques
• Neuraxial anesthesia is not contraindicated for spinal cord stimulator patients but must be placed below insertion level
• ECT can be performed with device turned off and careful electrode placement
• Devices should be turned back on before emergence from anesthesia
• Postoperative evaluation should include checking for thermal injuries and neurologic changes

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For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/253-when-electrocautery-meets-implanted-devices-what-every-anesthesia-professional-needs-to-know/

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