Summary
Vagus nerve stimulation is a well-established treatment option for patients with drug-resistant epilepsy and has
an expanding range of other clinical indications. Side effects of vagus nerve stimulation therapy include: cough;
voice changes; vocal cord adduction; rarely, obstructive sleep apnoea; and arrhythmia. Patients with implanted
vagus nerve stimulation devices may present for unrelated surgery and critical care to clinicians who are
unfamiliar with their function and safe management. These guidelines have been formulated by
multidisciplinary consensus based on case reports, case series and expert opinion to support clinicians in the
management of patients with these devices. The aim is to provide specific guidance on the management of
vagus 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 of the importance of carrying their personal
vagus nerve stimulation device magnet with them at all times to facilitate urgent device deactivation if
necessary. We advise that it is generally safer to formally deactivate vagus nerve stimulation devices before
general and spinal anaesthesia. During periods of critical illness associated with haemodynamic instability, we
also advise cessation of vagus nerve stimulation and early consultation with neurology services.