Vagal nerve stimulation: a case report

Despite numerous medications designed to eliminate or decrease seizures, an estimated 20% of epileptic patients in the United States remain refractory to these agents. Vagal nerve stimulation can decrease the number of seizure episodes. In 1997, the US Food and Drug Administration approved the first implantable stimulation device for the treatment of medically refractory epilepsy. This case report describes the anesthetic management of a patient for placement of a vagal nerve stimulator. A review is presented of the current literature regarding long-term antiepileptic drug therapy and its effect on anesthetic management, pathophysiology of epilepsy and seizure propagation, and the effects of commonly used anesthetic agents on the seizure threshold. Also discussed are the physiology of vagal nerve stimulation, benefits and potential complications that may occur with its implantation, and device mechanics as it relates to future surgical procedures. As the use of vagal nerve stimulators increases, knowledge of these processes is important to ensure safe and effective anesthetic management.