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Little Black Boxes: Noncardiac Implantable Electronic Medical Devices and Their Anesthetic and Surgical Implications

Srejic, Una MD*; Larson, Paul MD; Bickler, Philip E. MD, PhD

doi: 10.1213/ANE.0000000000001983
Technology, Computing, and Simulation: Narrative Review Article
Continuing Medical Education

Implanted electronic medical devices. or stimulators such as pacemakers and nerve stimulators have grown enormously in diversity and complexity over recent decades. The function and potential interaction of these devices with the perioperative environment is of increasing concern for anesthesiologists and surgeons. Because of the innate electromagnetic environment of the hospital (operating room, gastrointestinal procedure suite, and imaging suite), implanted device malfunction, reprogramming, or destruction may occur and cause physical harm (including nerve injury, blindness, deafness, burn, stroke, paralysis, or coma) to the patient. It is critical for the anesthesiologist and surgeon to be aware of the function and interaction of implanted devices, both with other implanted devices and procedures (such as magnetic resonance imaging and cardioversion) in the hospital environment. Because of these interactions, it is imperative that proper device function is assessed when the surgical procedure is complete. This review article will discuss these important issues for 12 different types of “little black boxes,” or noncardiac implantable electronic medical devices.

From the *Department of Anesthesia and Perioperative Care, University of California, San Francisco; Neurosurgery Service, Veterans Affairs Medical Center, Movement Disorders Research, San Francisco, California; and Neurosurgical Anesthesia Department, San Francisco, California.

Accepted for publication January 19, 2017.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Una Srejic, MD, Department of Anesthesia and Perioperative Care, University of California, San Francisco, 505 Parnassus Ave, L08 San Francisco, CA 94143-0648. Address e-mail to,

© 2017 International Anesthesia Research Society
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