The Experts below are selected from a list of 822 Experts worldwide ranked by ideXlab platform

Rodolfo Gebhardt - One of the best experts on this subject based on the ideXlab platform.

  • SynchroMed II Intrathecal Pump Memory Errors Due to Repeated Magnetic Resonance Imaging
    Pain Physician, 2012
    Co-Authors: Rodolfo Gebhardt
    Abstract:

    Cancer patients with severe refractory pain are often managed with implantable drug delivery systems (IDDS). The only drugs with US Food and Drug Administration approval for Intrathecal use are morphine, ziconotide, and baclofen. Other drugs used and mixed include, hydromorphone, bupivacaine, sufentanil, and fentanyl. These patients often undergo magnetic resonance imaging (MRI) for disease-related monitoring and diagnoses. Although uncommon, IDDS can fail to resume normal functioning after MRI, potentially causing complications. The magnetic field of an MRI will temporarily stop the rotor of the Pump motor and suspend drug delivery for the duration of the MRI exposure. The Pump should resume normal operation when removed from the MRI magnetic field, but there is a potential for a delay in the return of proper drug infusion and a delay in the logging of motor stall events after an MRI in the SynchroMed II Pumps. A 57-yearold man who underwent multiple MRIs with an implanted IDDS experienced 2 separate memory failures leading to multiple complications. After the first Pump malfunction, the patient developed withdrawal symptoms and was treated in the emergency department. The first time, a memory reset resolved the problem. The second time, 29 months later, the patient was admitted to the hospital to manage withdrawal symptoms and the Pump had to be exchanged with a new device. Post-MRI Pump interrogation should be performed on all patients with IDDS to ensure proper functioning of the Pump. Special attention should be paid to patients receiving baclofen, as acute withdrawal can be very serious, even deadly. Key words: Cancer pain, MRI, IDDS, SynchroMed II, baclofen, withdrawal, stall.

  • SynchroMed II Intrathecal Pump memory errors due to repeated magnetic resonance imaging.
    Pain physician, 2012
    Co-Authors: Alyssa K. Kosturakis, Rodolfo Gebhardt
    Abstract:

    Cancer patients with severe refractory pain are often managed with implantable drug delivery systems (IDDS). The only drugs with US Food and Drug Administration approval for Intrathecal use are morphine, ziconotide, and baclofen. Other drugs used and mixed include, hydromorphone, bupivacaine, sufentanil, and fentanyl. These patients often undergo magnetic resonance imaging (MRI) for disease-related monitoring and diagnoses. Although uncommon, IDDS can fail to resume normal functioning after MRI, potentially causing complications. The magnetic field of an MRI will temporarily stop the rotor of the Pump motor and suspend drug delivery for the duration of the MRI exposure. The Pump should resume normal operation when removed from the MRI magnetic field, but there is a potential for a delay in the return of proper drug infusion and a delay in the logging of motor stall events after an MRI in the SynchroMed II Pumps. A 57-year-old man who underwent multiple MRIs with an implanted IDDS experienced 2 separate memory failures leading to multiple complications. After the first Pump malfunction, the patient developed withdrawal symptoms and was treated in the emergency department. The first time, a memory reset resolved the problem. The second time, 29 months later, the patient was admitted to the hospital to manage withdrawal symptoms and the Pump had to be exchanged with a new device. Post-MRI Pump interrogation should be performed on all patients with IDDS to ensure proper functioning of the Pump. Special attention should be paid to patients receiving baclofen, as acute withdrawal can be very serious, even deadly.

Amitabh Gulati - One of the best experts on this subject based on the ideXlab platform.

  • interventional pain treatments in the management of oncologic patients with thoracic spinal tumor related pain a case series
    Pain Practice, 2019
    Co-Authors: Leia Rispoli, Neal Rakesh, Rita Shah, Amitabh Gulati
    Abstract:

    BACKGROUND: Advanced tumors of the thoracic spine are difficult to treat and can lead to complex pain syndromes. Following conventional oncologic treatments, pharmacologic therapy may be insufficient to manage pain. Minimally invasive interventional procedures offer alternatives to treat malignant thoracic spinal pain. METHODS: Thirteen patients with metastatic disease and poorly controlled thoracic axial and/or radicular pain were identified via a retrospective chart review. Patients were either treated with radiation, surgery, chemotherapy, or a combination of these. Then, the patients were organized into groups based on their diagnoses, anatomical disease locations, symptoms, prior treatments, and interventional pain procedures offered. RESULTS: All cases of intercostal nerve, costotransverse junction, erector spinae plane, and paravertebral blocks resulted in pain relief without any reported complications. A patient who received a thoracic epidural injection had a complete resolution of pain when combined with radiation therapy 2 weeks after the injection. One patient who underwent repeat thoracic epidural injections eventually had an Intrathecal Pump placement, resulting in reduced opioid usage. Finally, 1 patient who received a thoracic medial branch block with a relief of thoracic axial pain reported greater pain relief with a medial branch nerve cryoablation. CONCLUSION: We propose a treatment algorithm to manage patients with thoracic spinal tumor-related pain. Interventional thoracic axial procedures may be safe and efficacious pain treatments for patients with cancer.

  • a retrospective review and treatment paradigm of interventional therapies for patients suffering from intractable thoracic chest wall pain in the oncologic population
    Pain Medicine, 2015
    Co-Authors: Amitabh Gulati, Vinay Puttanniah, Rajiv Shah, Joseph C Hung, Vivek Malhotra
    Abstract:

    Introduction Tumors invading the chest wall and pleura are often incurable, and treatment is targeted toward palliation of symptoms and control of pain. When patients develop tolerance or side effects to systemic opioid therapy, interventional techniques can better optimize a patient's pain. We performed a retrospective review of 146 patients from April 2004 to January 2014 who underwent diagnostic and therapeutic procedures for pain relief. Using four patients as a paradigm for neurolytic approaches to pain relief, we present a therapeutic algorithm for treating patients with intractable thoracic chest wall pain in the oncologic population. Material and Methods For each patient, we describe the use of intercostal/paravertebral nerve blocks and neurolysis, pulsed radiofrequency ablation (PRFA) of the thoracic nerve roots, or Intrathecal Pump placement to successfully treat the patient's chest wall pain. Analysis of 146 patient charts is also performed to assess effectiveness of therapy. Results Seventy-nine percent of patients undergoing an intercostal nerve diagnostic blockade (with local anesthetic and steroid) stated that they had improved pain relief with 22% having prolonged pain relief (average of 21.5 days). Only 32% of successful diagnostic blockade patients elected to proceed to neurolysis, with a 62% success rate. Seven patients elected to proceed to Intrathecal drug delivery. Discussion Intercostal nerve diagnostic blockade with local anesthetic and steroid may lead to prolonged pain relief in this population. Furthermore, depending on tumor location, we have developed a paradigm for the treatment of thoracic chest wall pain in the oncologic population.

  • Intrathecal pain Pump infusions for intractable cancer pain an algorithm for dosing without a neuraxial trial
    Anesthesia & Analgesia, 2013
    Co-Authors: Vivek Malhotra, James Root, Joseph Kesselbrenner, Innocent Njoku, Kenneth Cubert, Amitabh Gulati, Vinay Puttanniah, Mark H Bilsky, Michael G Kaplitt
    Abstract:

    BACKGROUND Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an Intrathecal Pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial Intrathecal Pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. METHODS We used data pre- and postPump from 46 cancer patients receiving systemic opioids undergoing Intrathecal Pump placement in the last 6 years, all of whom had undergone an epidural trial before Pump placement. RESULTS By analyzing Intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancer patients, an appropriate initial dose for an Intrathecal Pump based on the prePump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible. CONCLUSIONS When an epidural trial is not feasible and an Intrathecal Pump is required in a cancer patient, it is possible to predict an initial dose for the Intrathecal Pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.

Hariharan Shankar - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided localization of difficult to access refill port of the Intrathecal Pump reservoir
    Neuromodulation, 2009
    Co-Authors: Hariharan Shankar
    Abstract:

    Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an Intrathecal Pump. Case Report. A 56-year-old patient with a programmable implanted Intrathecal drug delivery system for chronic non-malignant pain needed a Pump refill of sufentanil. Attempts to access the refill port using the manufacturer supplied template were difficult because of the presence of a seroma. Using ultrasound guidance, the seroma, reservoir, and the refill port were visualized and the Pump was successfully accessed. This imaging-guided refill technique is fully described in this article. As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a Pump reservoir secondary to the formation of a seroma.

  • Ultrasound‐Guided Localization of Difficult‐to‐Access Refill Port of the Intrathecal Pump Reservoir
    Neuromodulation : journal of the International Neuromodulation Society, 2009
    Co-Authors: Hariharan Shankar
    Abstract:

    Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an Intrathecal Pump. Case Report. A 56-year-old patient with a programmable implanted Intrathecal drug delivery system for chronic non-malignant pain needed a Pump refill of sufentanil. Attempts to access the refill port using the manufacturer supplied template were difficult because of the presence of a seroma. Using ultrasound guidance, the seroma, reservoir, and the refill port were visualized and the Pump was successfully accessed. This imaging-guided refill technique is fully described in this article. As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a Pump reservoir secondary to the formation of a seroma.

Margret Hund-georgiadis - One of the best experts on this subject based on the ideXlab platform.

  • Intrathecal Pump catheter-tip granuloma recurrence with associated myelomalacia - How safe is Intrathecal analgesic infusion therapy? A case report.
    Surgical Neurology International, 2019
    Co-Authors: Moritz Haering, Christian Saleh, Phillip Jaszczuk, Markus Koehler, Margret Hund-georgiadis
    Abstract:

    Background: A serious complication of Intrathecal (IT) infusion therapy for pain management is catheter-tip-associated granuloma. Catheter-tip granulomas can lead to permanent severe neurological sequelae if not promptly detected. Case Description: We report a patient with a recurrence of a catheter-tip granuloma causing a high-grade paresis of the lower extremities and we review briefly the literature. Conclusion: Patients with IT Pump therapy presenting new neurological findings need prompt imaging of the spinal axis to rule out a catheter-tip granuloma. In case of catheter-tip granuloma, early surgical decompression is important.

Dieter Pöhlau - One of the best experts on this subject based on the ideXlab platform.

  • Successful treatment of methicillin-resistant Staphylococcus aureus meningitis using linezolid without removal of Intrathecal infusion Pump. Case report.
    Journal of neurosurgery, 2007
    Co-Authors: Ulf Kallweit, Michael Harzheim, Günter Marklein, Tobias Welt, Dieter Pöhlau
    Abstract:

    Infection of an Intrathecal Pump system is a rare but serious complication and usually leads to the removal of the Pump. The authors report the first case of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in a patient with such a Pump successfully treated with linezolid without the need for removal of the Intrathecal Pump. A 77-year-old woman with cervical myelopathy underwent implantation of an Intrathecal Pump system for baclofen administration. Two weeks after the procedure she developed meningitis caused by MRSA as isolated in cerebrospinal fluid (CSF) cultures, blood samples, and serum obtained from the Pump pouch. Clinically she presented with meningism, somnolence, and signs of sepsis. When a combined intravenous antibiotic treatment regimen of vancomycin and rifampicin resulted in no clinical improvement, that regimen was discontinued and linezolid was administered intravenously as monotherapy. Within 3 days clinical and laboratory findings showed significant improvement. After 1 week of linezolid treatment, blood and CSF cultures were sterile. Intravenous treatment was administered for a total of 3 weeks, after which the patient was treated with oral linezolid for 3 months. During 18 months of follow-up, no new clinical or laboratory signs of infection were observed. These results confirm previous reports of the efficacy of linezolid for the treatment of severe infections of the central nervous system caused by multidrug-resistant Gram-positive bacteria, especially postneurosurgical infections.