Perioperative and Periprocedural Care of Patients With Intrathecal Pump Therapy

Nadherny, Weston; Anderson, Brooke; Abd‐Elsayed, Alaa

doi:10.1111/ner.12880

Cited by 14 publications

(14 citation statements)

References 40 publications

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“…For analgesic management, the pain surgeon may administer an intrathecal bolus to initiate therapy immediately after surgery or for postoperative pain management (21). Care must be taken to avoid additional opioid or sedative doses and the staff of the postanesthetic recovery unit must be informed of the potential consequences of neuraxial doses of those medications, including respiratory depression, hypotension and skin reactions (22).…”

Section: Postoperative Periodmentioning

confidence: 99%

“…A consult with the pain treating physician is needed whenever possible in order to have a clear idea of the device the patient utilizes, the time of use, the last time the pump was checked, the current medication in the pump and whether the dose is on demand or flexible; also, it is important to ascertain when the patient needs to reload the medication in the pump (22).…”

Section: Anesthetic Considerations In Patients With Neuromodulation Devices Preoperative Periodmentioning

confidence: 99%

“…Opioid infusions must be used cautiously in patients with IDDS, and multimodal analgesia with adjuncts including NSAID, acetaminophen, steroids and ketamine should be administered (47). In the event the IDDS is damaged during surgery and no immediate repair is possible, the pump must be stopped and the patient should be switched to oral or intravenous opioid postoperatively (47), bearing in mind that there is no reliable way to make the conversion from the equianalgesic opioid dose to an intravenous drug (22). Estimates of equianalgesic doses when rotating from oral administration to intrathecal morphine administration range between 12:1 and 300:1 (Table 1) (51); consequently, the dose calculation according to opioid equianalgesia with morphine must be taken into account (Table 2) and then adjust the equivalent dose to the route of administration used.…”

Section: Intraoperative Periodmentioning

confidence: 99%

“…If patient temperature rises, the temperature of the device could also rise, leading to increased drug delivery and potential overdosing. Infusion pump manufacturers recommend that temperature should not exceed 39°C if the risk of altering the infusion rate is to be minimized (22).…”

Section: Intraoperative Periodmentioning

confidence: 99%

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Anesthetic considerations in patients with implantable devices and chronic pain surgery

Cárdenas

Cataño

Vargas

2021

Colomb. J. Anesthesiol.

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The use of advanced invasive techniques for the control of chronic pain in patients with multiple comorbidities is becoming increasingly common. Neuromodulation offers a new management alternative involving the infusion of one or more drugs into the epidural or intrathecal space through a fully implantable infusion pump. It also involves spinal stimulation, a minimally invasive technique in which electrodes are positioned in the epidural space and connected to a pulse generator that is implanted subcutaneously and generates pulses designed to suppress the noxious stimulus. This article will describe the anesthetic considerations in cases of implantable drug delivery systems, and spinal and peripheral nerve stimulation devices. Additionally, patients with electrical or drug neuromodulation devices may present to anesthetic practice for surgical indications unrelated to their chronic pain pathology. Hence the importance of being familiar with the basic components of these devices, how they work, what drugs they use and the potential associated complications in the perioperative context, in order to ensure proper management and patient safety.

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Section: Postoperative Periodmentioning

confidence: 99%

Section: Anesthetic Considerations In Patients With Neuromodulation Devices Preoperative Periodmentioning

confidence: 99%

Section: Intraoperative Periodmentioning

confidence: 99%

Section: Intraoperative Periodmentioning

confidence: 99%

See 2 more Smart Citations

Anesthetic considerations in patients with implantable devices and chronic pain surgery

Cárdenas

Cataño

Vargas

2021

Colomb. J. Anesthesiol.

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“…There is a need for high-quality coordinated medical and surgical care for comorbidities through consultation, education, and collaboration with other physicians regarding concerns that may not be directly "pain-related" in patients with an IDDS to optimize outcomes and experience. 11,12…”

Section: Introductionmentioning

confidence: 99%

North American Neuromodulation Society Educational Curriculum for Intrathecal Drug Delivery Systems Implantation and Management

Chaiban¹,

Abdallah²,

Abd‐Elsayed³

et al. 2023

Neuromodulation: Technology at the Neural Interface

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Objectives: Intrathecal drug delivery systems (IDDSs) are used for the treatment of pain and spasticity. A wide range of educational criteria exist for these devices. The North American Neuromodulation Society (NANS) Education Committee developed a comprehensive IDDS curriculum to function as a standard for physician graduate education and assessment through training and into practice.Material and Methods: A multidisciplinary and diverse task force gathered by the NANS Education Committee met in person and virtually over several sessions and developed an IDDS curriculum modeling their previous work on spinal cord stimulation and following the Accreditation Council for Graduate Medical Education (ACGME) Milestones. There were iterative revisions and adaptations to the curriculum, and the final version was approved by the NANS Board of Directors. Results:The curriculum was developed with distinction between implanting physicians and managing physician and physicians who perform both tasks. There is a lateral temporal progression from early learner to practitioner, with advanced learner in the middle. In addition, there is a modular vertical organization that divides the curriculum into the six educational competencies outlined by the ACGME.

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Extending Drug Release from Implants via Transcutaneous Refilling with Solid Therapeutics

Trani

Pons‐Faudoa

Sizovs

et al. 2021

Advanced Therapeutics

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Long-acting (LA) implantable drug delivery systems (IDDS) offer an effective approach for the management or prevention of chronic conditions by sustained parenteral therapeutic administration. LA IDDS can and improve adherence to treatment regimens by minimizing dosing frequency. However, their clinical deployment is challenged by factors such as, poor drug loading capacity, which limit their lifespan and require repeated surgical replacement for continued therapy. To address these challenges, and by leveraging previous work on nanofluidic systems, a reservoir-based IDDS that enables transcutaneous refilling of solid drug formulations through minimally invasive needle injection is presented. With 1000-fold higher drug loading efficiency, the implant affords minimal volume and aspect ratio suitable for discrete subcutaneous deployment. Key parameters for clinical acceptability, namely, implant safety, access port robustness, and refilling method are systematically evaluated. The implant and refilling procedure are studied in rats and nonhuman primates with therapeutics used clinically for type 2 diabetes and human immunodeficiency virus pre-exposure prophylaxis. The ability to extend drug release and maintain equivalent pharmacokinetics profiles preand post-drug refilling is demonstrated. This technology presents a clinically viable LA approach to prolong drug release for lifelong prevention or management of chronic conditions.

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Perioperative and Periprocedural Care of Patients With Intrathecal Pump Therapy

Cited by 14 publications

References 40 publications

Anesthetic considerations in patients with implantable devices and chronic pain surgery

Anesthetic considerations in patients with implantable devices and chronic pain surgery

North American Neuromodulation Society Educational Curriculum for Intrathecal Drug Delivery Systems Implantation and Management

Extending Drug Release from Implants via Transcutaneous Refilling with Solid Therapeutics

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