Severe hyperthermia due to oral baclofen withdrawal.

We report a case of a 53-year-old woman who presented initially with sepsis and later in her stay developed a severe and rapidly progressing hyperthermia after a decrease in oral baclofen dosage. Her fever peaked at 42.5○C (108.5○F), creating a broad differential diagnosis and complicating her initial sepsis diagnosis. When the oral baclofen dose was increased, the fevers resolved which confirmed the clinical diagnosis of baclofen withdrawal. Dose reductions of oral baclofen should be made gradually and with caution, and patients should be monitored for fevers as a possible symptom of baclofen withdrawal.

Anesthetic Considerations and Perioperative Management of Sacral Neuromodulators: Literature Review and Initial Recommendations.

OBJECTIVE: Sacral neuromodulation (SNM) is gaining increased integration in the realm of medicine. With increasing use, anesthetic and periprocedural considerations must be understood. The goal of this article is to review and consolidate available literature on device management in these settings. MATERIALS AND METHODS: Searches were preformed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic searches were systematically conducted in the PubMed and Embase databases. RESULTS: Literature is reported on device management in the following settings: general operating room recommendations, electrocautery, ultrasound and other forms of diathermy, implanted cardiac devices, defibrillation, and magnetic resonance imaging. DISCUSSION: SNM devices have shown efficacy in treatment for a wide array of conditions. When proper precautions and guidelines are followed, the device can be safely and appropriately integrated in clinical practice. CONCLUSIONS: Available information on management in a variety of periprocedural settings is summarized. However, there are areas that lack satisfactory information, which are highlighted throughout the article.

Efficacy of Electrical Spinal Cord Stimulation with Neuromodulating Medications: A Systematic Review.

Background: Chronic pain is a prevalent and debilitating problem for millions of people and spinal cord stimulation (SCS) is one option for treatment. It has been shown to have membrane stabilizing properties and is often used in conjunction with medications that are also believed to offer pain control through membrane stabilization. Objective: The goal of this review is to analyze the effects of SCS combined with medications to evaluate for augmentative therapeutic effect. Setting: Systematic review. Methods: A systematic computerized search of the literature was conducted using PubMed, the Cochrane Library, and EMBASE for articles published in English. Results: We report three articles that discuss the potential for augmentative effects of medication in combination with SCS. Located articles related primarily to SCS combined with Gabapentin, TCA, or SNRI. Limitations: The limited number of articles reflects a need for more investigation in this area. Conclusion: Based on the suspected mechanisms for SCS and neuromodulating medications, there is reason to believe adding these medical therapies may enhance the effects of SCS.

Periprocedural Considerations for Patients with Gastric Electrical Stimulators.

OBJECTIVES: Gastric electrical stimulation (GES) is a technology that uses neurostimulation for the modulation of gastric activity. In clinical practice, the most commonly encountered form of GES is high frequency GES. GES devices are typically used for the treatment of refractory gastroparesis, although they have also been investigated for obesity management and the treatment of refractory gastroesophageal reflux disease. Just as many patients with chronic diseases require surgery, patients with an implanted GES device may encounter the need for periprocedural care. Therefore, the purpose of this review is to address the special needs of patients with an implanted GES device. MATERIALS AND METHODS: A systematic computerized search of the literature was performed to consolidate existing knowledge on GES management in the periprocedural setting. Duplicate results were eliminated, and results were further narrowed based on title and abstract. All articles with possible relevance were then reviewed in full. Manufacturer information including pamphlets and websites were also reviewed. RESULTS: A total of 1201 articles were identified for initial review, and 33 met inclusion criteria. CONCLUSIONS: Available data suggests GES is a technology with increasing prevalence. When patients with an implanted GES device present for periprocedural care, the anesthesia staff must consider the device when planning for the procedure. Topics addressed include general anesthetic considerations, nerve localization, radiation exposure, electrocautery, diathermy, emergency external defibrillation, and MRI compatibility.

Perioperative and Periprocedural Care of Patients With Intrathecal Pump Therapy.

INTRODUCTION: There are an ever-increasing number of patients who have implanted devices for targeted delivery of drug therapy to the intrathecal space for the management of spasticity or chronic pain. This leads to a growing number of people with implanted pumps presenting for procedures and surgeries, yet there is a paucity of consolidated information available to describe the appropriate precautions and patient management during this period. METHODS: This was a systematic review to provide a summary of existing literature on intrathecal drug delivery system (IDDS) management in the perioperative and procedural period, and to highlight additional areas that require further research. Topics addressed include the time surrounding magnetic resonance imaging, defibrillation, radiation therapy, high output ultrasound, lithotripsy, ablation, diathermy, electroconvulsive therapy, and the perioperative period, all of which have their own specific considerations. RESULTS: A total of 42 articles met criteria to be included in this review. Inclusion criteria were English language, and that the article was primarily focused on the perioperative or periprocedural management of IDDSs. Exclusion criteria included commentaries, surveys, published abstracts, or articles that did not discuss the perioperative or periprocedural care of IDDS. CONCLUSION: Our article outlined perioperative considerations when dealing with a patient with intrathecal pump undergoing surgical or imaging modality.