Anesthetic Management of Patients for Vagal Nerve Stimulator Placement: A Narrative Review

Comprehensive Summary

This paper aims to provide an overview of anesthetic management considerations for vagal nerve stimulator (VNS) implantation. Ultimately, the goal is to help anesthesiologists improve patient safety and operative outcomes during VNS implantation. VNS is a neuromodulation therapy that has many purposes, including drug-resistant epilepsy. This therapy works by sending electrical impulses through the vagus nerve to the brain and can influence neural pathways related to seizures and mood. The implantation involves an incision to the left vagus nerve and placement of electrodes around this nerve, while the pulse generator is implanted into the upper chest. The authors conducted a literature review surrounding clinical trials, cohort studies, review articles, and device safety analysis. They evaluated patient histories, as well as potential interactions and risks associated with VNS and surgical equipment. The findings show that general anesthesia with endotracheal intubation is the most common approach. The Vagus nerve manipulation can result in bradycardia, hypotension, and, rarely asystole. The postoperative findings show that patients are first monitored for factors such as airway obstruction and seizure occurrence, and that their pain control should balance the need to avoid respiratory depression with the need to provide adequate analgesia. The VNS implantation introduces unique anesthetic challenges due to device characteristics and surgical locations near the airway. The authors emphasize that there is a need for standardized management strategies for VNS therapy.

Outcomes and Implications

In order to increase the use of VNS, anesthesiologists should be aware of how the device functions and the operative risks. Improved protocols surrounding VNS can help to reduce complications as well as improve patient safety. However, the authors urge the need for future research surrounding optimal anesthetic techniques and improving long-term outcomes.