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 changesThanks 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

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