Airway obstruction during general anaesthesia in a patient with a vagal nerve stimulator

Abstract

For patients with epilepsy refractory to medical management, vagal nerve stimulator implantation may reduce the number of seizures and/or reduce their severity. A 34-year-old woman with epilepsy underwent a change in vagal nerve stimulator battery under general anaesthesia with a supraglottic airway device and total intravenous anaesthesia. During the procedure, she developed clinically significant airway obstruction, which resolved only when the device was disabled. We recommend that anaesthetists and others providing peri-operative care for patients with a vagal nerve stimulator remain vigilant to the possibility of device-related airway obstruction, which may occur even in asymptomatic patients. All patients with a vagal nerve stimulator are provided with a magnet that will disable the device, should complications arise. There is a need to establish a standard approach to the peri-operative care of these patients, including the identification and management of devicerelated airway obstruction.

Management of vagus nerve stimulation therapy in the peri‐operative period

“…This may predispose to airway obstruction under general anaesthesia and may also increase the risk of aspiration. There are a limited number of reported cases describing clinically significant airway obstruction under general anaesthesia in the presence of a supraglottic airway device and an active VNS device, thought to be caused by VNS-induced left vocal cord adduction [25,26].…”

Novel presentations, rare complications and educational content: cases in clinical practice

“…Most will never have anaesthetised a patient with a vagal nerve stimulator, but it turns out they may be associated with an unusual peri-operative problem. Gibbins et al demonstrate how for their case, the vagal nerve stimulator may have precipitated airway obstruction during a routine battery change procedure [17]. They conclude there should be consensus or guidelines as to the peri-operative management of patients with these devices.…”