#253 When Electrocautery Meets Implanted Devices: What Every Anesthesia Professional Needs to Know

Anesthesia Patient Safety Podcast

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
Thanks for joining us for our 253rd episode! Wow, 250 and counting! Go tell a friend or colleague about our show as we work toward 500 episodes. If you enjoy the Anesthesia Patient Safety Podcast, please give us a five-star rating, subscribe, and share with colleagues.
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/

© 2025, The Anesthesia Patient Safety Foundation

Chapters

1. Podcast Introduction & Milestone (00:00:00)

2. Preoperative Considerations Review (00:01:43)

3. Electrocautery Risks & Management (00:03:22)

4. Intraoperative Neuromonitoring Challenges (00:08:13)

5. MRI Safety Protocols (00:09:58)

6. Regional & Neuraxial Anesthesia Guidelines (00:12:55)

7. ECT Safety for Device Patients (00:16:25)

8. Postoperative Care & Future Outlook (00:19:31)