John Riordan1, Paul Murphy1. 1. Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland.
Abstract
SETTING: Intrathecal baclofen is an established method of treating spasticity. However, this therapy is not without significant morbidity and mortality. The known morbidity associated with intrathecal pumps includes death, infection, and sepsis including central nervous system infection, accidental overdose, wrong drug administration as well as technical failures such as pump or battery failure, catheter migration or catheter breakage. Medtronic has issued a number of advisories, most recently in June 2013, regarding the safety of the Medtronic SynchroMed II intrathecal pumps. PATIENT: Sixty-four months post insertion of a SynchroMed II, model 8637; our patient was reviewed as a matter of urgency by our team, as he was complaining of worsening spasticity and pain. The device was interrogated and this indicated a motor stall at the time of interrogation. The interrogation also revealed that this was the third period of motor stall in the preceding three days. According to the patient, and consistent with our interrogation, the device had been alarming intermittently for the previous three days. INTERVENTION: He was commenced on oral baclofen overnight, which gave some improvement to his symptoms. A replacement intrathecal pump was inserted the following day. This provided the patient with his usual level of relief. The product Engineering Department at Medtronic reviewed the original pump. OUTCOME: The patient's new intrathecal pump has been functioning uneventfully since its replacement and he continues to receive good symptom relief from his new pump. Internal inspection of the pump by the Engineering Department at Medtronic revealed corrosion of the motor gearbox. CONCLUSION: Our unit continues to retain a high level of vigilance when dealing with potential complications of intrathecal pump therapy. Supplemental oral baclofen may have a role in this setting.
SETTING: Intrathecal baclofen is an established method of treating spasticity. However, this therapy is not without significant morbidity and mortality. The known morbidity associated with intrathecal pumps includes death, infection, and sepsis including central nervous system infection, accidental overdose, wrong drug administration as well as technical failures such as pump or battery failure, catheter migration or catheter breakage. Medtronic has issued a number of advisories, most recently in June 2013, regarding the safety of the Medtronic SynchroMed II intrathecal pumps. PATIENT: Sixty-four months post insertion of a SynchroMed II, model 8637; our patient was reviewed as a matter of urgency by our team, as he was complaining of worsening spasticity and pain. The device was interrogated and this indicated a motor stall at the time of interrogation. The interrogation also revealed that this was the third period of motor stall in the preceding three days. According to the patient, and consistent with our interrogation, the device had been alarming intermittently for the previous three days. INTERVENTION: He was commenced on oral baclofen overnight, which gave some improvement to his symptoms. A replacement intrathecal pump was inserted the following day. This provided the patient with his usual level of relief. The product Engineering Department at Medtronic reviewed the original pump. OUTCOME: The patient's new intrathecal pump has been functioning uneventfully since its replacement and he continues to receive good symptom relief from his new pump. Internal inspection of the pump by the Engineering Department at Medtronic revealed corrosion of the motor gearbox. CONCLUSION: Our unit continues to retain a high level of vigilance when dealing with potential complications of intrathecal pump therapy. Supplemental oral baclofen may have a role in this setting.
Authors: Mya Caryn Schiess; Sam Eldabe; Peter Konrad; Lisa Molus; Robert Spencer; Katherine Stromberg; Todd Weaver; Robert Plunkett Journal: Neuromodulation Date: 2020-01-27