Obstetric Anaesthesia Annual Scientific Meeting 2026

Anaesthetic Management of an Implanted Vagal Nerve Stimulator During Elective Caesarean Section: A Case Report

Dr K. Walker, Dr A. Bunce
University Hospitals of Derby and Burton NHS Foundation Trust (UHDB)

Introduction

- Vagal nerve stimulation (VNS) is a clinically established neuromodulation therapy designed principally for patients with medically refractory epilepsy and expanding indications such as treatment-resistant depression.
- Device usually implanted in the left subclavicular region.
- Limited guidance exists for caesarean delivery.
- MDT considerations: potential device–anaesthetic interactions, seizure risk, haemodynamic effects, electromagnetic interference and post-operative destination and care.

Case Report

Antenatal

•40 y/o multiparous patient referred to Anaesthetic antenatal clinic with complex epilepsy managed with a VNS, levetiracetam & clonazepam.

•Had VNS inserted in a different trust >10 years prior.

•Device formally deactivated on the day of surgery by Epilepsy Specialist Nurse.

Anaesthetic

•Neuraxial anaesthetisa using 25G Sprotte spinal needle, 2.7ml 0.5% hyperbaric bupivacaine + 300mcg Diamorphine.

•Phenylephrine infusion.

•Haemodynamically stable throughout the operative and post-operative period.

•Hospital standard uterotonic of oxytocin bolus followed by infusion.

Surgery

•Bipolar diathermy used by surgeons to reduce the risk of device damage and interference.

•Blood loss of 400ml.

•Uncomplicated delivery with no maternal or fetal compromise.

Post-op

•Transferred to Enhanced Care Unit within Labour Ward for 24 hours of monitoring.

•VNS re-activated by specialist at earliest opportunity.

•Successfully discharged postnatally with no complications encountered.

Discussion

- VNS delivers intermittent electrical pulses to the cervical vagus nerve to modulate pathological neural circuits and reduce seizure frequency and severity.

- Pregnant patients with epilepsy are at risk of seizure-related maternal and fetal morbidity and mortality.

- Spinal anaesthesia induces sympathectomy with relative parasympathetic predominance.

- Simultaneous VNS activity could theoretically exacerbate bradycardia and hypotension beyond typical spinal effects compromising uteroplacental perfusion, thus affecting fetal oxygenation.

Clinical Learning Points:

- Early anaesthetic review in specialist antenatal clinic, and familiarisation with VNS device

- MDT planning with Neurology, Epilepsy Specialist Nurse and Obstetrics

- Formal VNS deactivationprior to elective caesarean section under neuraxial block

- Magnet availability in theatre in case of an emergency (any magnet over 50 gauss can be used if VNS-specific magnet not available)

- Enhanced monitoring post-operatively, with prompt reactivation of device

References

[1] Broderick L, Tuohy G, Solymos O, et al. Management of vagus nerve stimulation therapy in the peri-operative period: Guidelines from the Association of Anaesthetists. Anaesthesia. 2023 Jun;78(6):747–757. https://doi.org/10.1111/anae.16012

[2] Morris GL, Gloss D, Buchhalter J, et al. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy. Epilepsy Currents. 2013;13:297–303.

Obstetric Anaesthesia Annual Scientific Meeting 2026

Anaesthetic management of an implanted vagal nerve stimulator during elective caesarean section: a case report

Poster Presenter

Authors

Affiliations

Part of Topic