2024 FSA Podium and Poster Abstracts
P050: CASE REPORT: ANESTHETIC MANAGEMENT AND CONSIDERATIONS OF A DIAPHRAGMATIC PACEMAKER PLACEMENT AFTER CERVICAL SPINE INJURY
Gordon J Hubbell, DO1; Tamara Stojilkovic, BS2; Raul Bermudez-Velez, MD3; 1HCA Florida Westside/Northwest Anesthesia; 2Kansas City University Medical School; 3HCA Florida Kendall Hospital
Introduction/Background: Diaphragmatic pacemakers are battery-implanted devices that assist in diaphragmatic contractions to improve breathing. These implants can be used to eliminate ventilator dependence in patients who meet certain criteria, and they can improve the quality of life for patients with high spinal cord injuries that affect diaphragm function. The anesthetic management of these patients during this procedure can be challenging and there are few existing case reports on this surgery. This case report discusses the anesthetic management and specific considerations involved in a patient who underwent a successful diaphragmatic pacemaker placement.
Methods/Results: We report a case of a 35-year-old male with past medical history of a traumatic high spinal cord injury resulting in complete cord syndrome and quadriplegia who underwent a successful diaphragmatic pacemaker placement. His month-long hospital course prior to this procedure included an anterior approach corpectomy, posterior C3-C7 instrumented fusion, C3-C6 with partial C7 bilateral decompressive laminectomies, bronchoscopy, tracheostomy, and percutaneous endoscopic gastrostomy. The diaphragmatic pacemaker placement involved using a laparoscopic approach, an avoidance of paralytics to adequately assess diaphragm function, careful cardiac monitoring with a high risk of arrythmias, and pre vs post ventilator monitoring to evaluate to efficacy of the pacemaker. This procedure can also be done robotically with the utilization of lung isolation for proper visualization and access to the diaphragm. Overall the procedure was successful and allowed our patient to have an improvement in quality of life which we confirmed upon follow up.
Conclusion/Discussion: The mainstays of management following acute high cervical spinal cord injury often lead to tracheostomy and mechanical ventilation, however with the introduction of the diaphragmatic pacemaker patients do not need to be ventilator dependent. This procedure can improve patient quality of life and is cost-effective. The placement of a diaphragmatic pacemaker has several unique challenges and understanding how to manage these patients anesthetically allows us to optimize care. This case report is an educational opportunity to navigate the anesthetic management for patients having this unique procedure.