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

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 device-related airway obstruction.