Electrosurgery and Implantable Electronic Devices: A Survey of Current Practices among Cutaneous Surgeons
Background: The use of electrosurgery within dermatology is widespread and the number of patients with an implantable electronic device (IED) is ever-increasing. Adverse effects of performing electrosurgery on patients with IEDs could pose a significant patient safety risk. There is a paucity of literature existing detailing guidelines for cutaneous surgeons regarding electrosurgery in IED patients.
Objective: To assess current practices and complications of cutaneous surgeons performing electrosurgery in IED patients.
Methods: An electronic survey was distributed to members of the American College of Mohs Micrographic Surgery using REDCap. Data was collected between March 2019 and May 2019.
Results: The survey was sent to approximately 1700 ACMS members with 178 responses received. The most commonly reported routine precautions included utilization of only short bursts of current, avoidance of electrosurgery around the device, and use of minimal power/lowest effective settings. In total there were nine complications with an estimated 31 patients experiencing electromagnetic interference (EMI) out of over 250,000 procedures. Complications were more commonly seen in patients with a cardioverter-defibrillator than any other device (RR:4.74, CI:1.29-17.4). The use of true heat cautery and bipolar (two-tip electrode) were associated with the lowest rate of EMI. Whereas, electrocoagulation, electrosection, and monopolar (single-tip electrode) were more likely to cause EMI (RR:3.62, 95% CI:1.82-7.19).
Conclusions: Significant EMI to IEDs during routine cutaneous electrosurgery procedures is rare, however, there is a clear lack of recommendations. The use of bipolar forceps and electrocautery may be safer when electrosurgery is required. Further investigation is required to develop guidelines for electrosurgery in IED patients.
El-Gamal HM, Dufresne RG, Saddler K. Electrosurgery, pacemakers and ICDs: a survey of precautions and complications experienced by cutaneous surgeons. Dermatol Surg. 2001;27(4):385-390.
Sebben JE. Electrosurgery and cardiac pacemakers. J Am Acad Dermatol. 1983;9(3):457-463.
LeVasseur JG, Kennard CD, Finley EM, Muse RK. Dermatologic electrosurgery in patients with implantable cardioverter-defibrillators and pacemakers. Dermatol Surg. 1998;24(2):233-240.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Levine PA, Balady GJ, Lazar HL, Belott PH, Roberts AJ. Electrocautery and pacemakers: management of the paced patient subject to electrocautery. Ann Thorac Surg. 1986;41(3):313-317.
Howe N, Cherpelis B. Obtaining rapid and effective hemostasis: Part II. Electrosurgery in patients with implantable cardiac devices. J Am Acad Dermatol. 2013;69(5):677 e671-677 e679.
Yu SS, Tope WD, Grekin RC. Cardiac devices and electromagnetic interference revisited: new radiofrequency technologies and implications for dermatologic surgery. Dermatol Surg. 2005;31(8 Pt 1):932-940.
Matzke TJ, Christenson LJ, Christenson SD, Atanashova N, Otley CC. Pacemakers and implantable cardiac defibrillators in dermatologic surgery. Dermatol Surg. 2006;32(9):1155-1162; discussion 1162.
Dawes JC, Mahabir RC, Hillier K, Cassidy M, de Haas W, Gillis AM. Electrosurgery in patients with pacemakers/implanted cardioverter defibrillators. Ann Plast Surg. 2006;57(1):33-36.
Tripathi S HE. Pacemakers, Deep Brain Stimulators, Cochlear Implants, and Nerve Stimulators: A review of common devices in the encountered in the patient undergoing dermatologic surgery. Dermatologic Surgery. 2019;In press.
Behan J, Higgins S, Wysong A. Safety of Cochlear Implants in Electrosurgery: A Systematic Review of the Literature. Dermatol Surg. 2017;43(6):775-783.
Martinelli PT, Schulze KE, Nelson BR. Mohs micrographic surgery in a patient with a deep brain stimulator: a review of the literature on implantable electrical devices. Dermatol Surg. 2004;30(7):1021-1030.
Questions and Answers about Activa Parkinson’s Disease Therapy. Medtronic. http://www.medtronic.com/neuro/parkinsons/activa_qa.html. Accessed.
Krull EA, Pickard SD, Hall JC. Effects of electrosurgery on cardiac pacemakers. J Dermatol Surg. 1975;1(3):43-45.
Riordan AT, Gamache C, Fosko SW. Electrosurgery and cardiac devices. J Am Acad Dermatol. 1997;37(2 Pt 1):250-255.
Weaver J, Kim SJ, Lee MH, Torres A. Cutaneous electrosurgery in a patient with a deep brain stimulator. Dermatol Surg. 1999;25(5):415-417.
Healey JS, Merchant R, Simpson C, et al. Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices. Can J Cardiol. 2012;28(2):141-151.
Pinski SL. Emergencies related to implantable cardioverter-defibrillators. Crit Care Med. 2000;28(10 Suppl):N174-180.
Boughton RS, Spencer SK. Electrosurgical fundamentals. J Am Acad Dermatol. 1987;16(4):862-867.
Fader DJ, Johnson TM. Medical issues and emergencies in the dermatology office. J Am Acad Dermatol. 1997;36(1):1-16; quiz 16-18
Abstract - 151 Full Article PDF - 28
- There are currently no refbacks.