Anesthesia management in patients with neurostimulators

Abstract

Neurostimulators are active implantable devices that clinicians use to perform diverse neuromodulation treatments in patients with neurological and non-neurological disorders. 1 Neuromodulation works on the principle of reverse engineering the disorder allowing the clinicians to think from a patient-system point of view. This enables them to personalize interventions by understanding the patient-specific pathophysiology that can translate insights from cognitive neuroscience into targeted therapies for various disorders. 2 Neurostimulators can be intracranial [deep brain stimulation (DBS)], neuraxial [spinal cord stimulation (SCS), sacral nerve stimulators], or peripheral (vagal nerve trigeminal nerve or other peripheral nerve stimulation). The number of patients using neurostimulators is growing rapidly, making it imperative for anesthesiologists to understand these devices and their potential interactions with other medical equipment. 3 The literature on perioperative management of patients with neurostimulators is scarce, and most of the information comes from case reports and manufacturer recommendations. In this review, we provide an overview of various neurostimulators, general considerations, and recommendations regarding the perioperative management of these patients for specific surgeries.