真Check for updatesAnaesthesia 2023doi:10.1111/anae.16012GuidelinesManagement of vagus nerve stimulation therapy in theperi-operative periodGuidelines from the Association of AnaesthetistsL.Broderick,1 G.Tuohy,2O.Solymos,3S.Lakhani,4 B.Staunton,5 P.Ennis,5 N.Clark,6I.K.Moppett,A.Chalissery,3 R.D.Kilbride,K.J.Sweeney,10D.O'Brien,10A.O'Hare,11A.Harvey12 and C.M.Larkin131 Neuroanaesthesia Fellow,5 Epilepsy Clinical Nurse Specialist,8 Consultant Neurologist,9 Consultant Neurologist/Neurophysiologist,10 Consultant Neurosurgeon,11 Consultant Neuroradiologist,13 Consultant Anaesthetist/Intensivist,Beaumont Hospital,Dublin,Ireland2Specialist Registrar,Rotunda Hospital,Dublin,Ireland3 Consultant Anaesthetist/Intensivist,St Vincent's University Hospital,Dublin,Ireland4 Consultant in Neuro-anaesthesia and Neurocriticalcare,The Walton Centre NHS Foundation Trust,Liverpool,UK6Consultant Paediatric Anaesthetist,Bristol Children's Hospital,Bristol,UK and Paediatric Neuro-anaesthesia Networkrepresentative7 Professor of Anaesthesia and Peri-operative Medicine,University of Nottingham,Nottingham,UK12 Consultant Anaesthetist,Royal Comwall Hospital Trust,Cornwall,UKSummaryVagus nerve stimulation is a well-established treatment option for patients with drug-resistant epilepsy and hasan expanding range ofother clinical indications.Side effects ofvagus nerve stimulation therapy include:cough;voice changes;vocal cord adduction;rarely,obstructive sleep apnoea;and arrhythmia.Patients with implantedvagus nerve stimulation devices may present for unrelated surgery and critical care to clinicians who areunfamiliar with their function and safe management.These guidelines have been formulated bymultidisciplinary consensus based on case reports,case series and expert opinion to support clinicians in themanagement of patients with these devices.The aim is to provide specific guidance on the management ofvagus nerve stimulation devices in the following scenarios:the peri-operative period;peripartum period;during critical illness;and in the MRI suite.Patients should be aware ofthe importance of carrying their personalvagus nerve stimulation device magnet with them at all times to facilitate urgent device deactivation ifnecessary.We advise that it is generally safer to formally deactivate vagus nerve stimulation devices beforegeneral and spinal anaesthesia.During periods of critical illness associated with haemodynamic instability,wealso advise cessation ofvagus nerve stimulation and early consultation with neurology services.Correspondence to:C.M.LarkinEmail:carolinelarkin@beaumont.ieAccepted:6 March 2023Keywords:complications;epilepsy;vagus nerve stimulatorThis is a consensus document produced by expert members of a Working Party established by the Association of Anaesthetists.It has been seen and approved by the Board of Directors of the Association of Anaesthetists and has been endorsed by the RoyalCollege ofAnaesthetists.Twitter:@carolinemlarkinRe-use of this article is permitt
