From the Research
It is generally not necessary to turn off a sacral nerve stimulator (SNS) during an open femoral endarterectomy, as the risk of interference between the stimulator and the surgical site is minimal. The SNS can typically remain active during this vascular procedure, given the anatomical distance between the femoral artery in the groin/upper thigh area and the SNS electrodes positioned near the sacral nerves in the lower back. However, if electrocautery will be used extensively during the procedure, it may be prudent to temporarily deactivate the SNS to prevent potential electrical interference that could damage the device or cause uncomfortable stimulation, as suggested by the principles outlined in studies such as 1.
The surgical team should be informed about the presence of the SNS before surgery, and the device manufacturer's guidelines should be consulted for specific recommendations. Most modern SNS devices are MRI-conditional and designed to withstand common surgical electromagnetic interference, but this varies by model and manufacturer, as noted in various studies including 2 and 3. After surgery, if the device was turned off, it should be reactivated to maintain control of bladder or bowel symptoms for which it was implanted. The decision to deactivate or keep the SNS active should prioritize minimizing risks and ensuring the patient's safety and comfort, aligning with the precautionary principle discussed in 4, while also considering the specific details of the procedure and the device's specifications.
Key considerations include:
- Informing the surgical team about the SNS
- Consulting device manufacturer's guidelines
- Potential temporary deactivation if electrocautery is used extensively
- Reactivating the device post-surgery if it was turned off
- Prioritizing patient safety and comfort, guided by the most recent and highest quality evidence available, such as 1, which provides an overview of anesthetic considerations and perioperative management of sacral neuromodulators.