Severe bradycardia in a child with an implanted vagus nerve stimulator undergoing laparoscopy -A case report-

Background: Vagus nerve stimulation is an established therapeutic option for children with drug-resistant epilepsy who do not respond to other treatments. During surgical procedures, this therapy has various anesthetic implications and may result in critical respiratory and cardiac complications. Case: We report the case of a 13-year-old child with an implanted vagus nerve stimulator who underwent laparoscopy-assisted gastrostomy tube placement under general anesthesia with the device activated. A severe episode of bradycardia occurred during pneumoperitoneum, which was successfully managed pharmacologically, without external device deactivation. The rationale for this management decision is discussed and reflections based on the clinical course are provided. Conclusions: Perioperative management of vagus nerve stimulators must be individualized. Maintaining device activation may be reasonable in children with recent seizure activity, whereas temporary deactivation may be considered during procedures associated with a high risk of vagal reflex. However, in cases requiring immediate deactivation, pharmacological intervention may be necessary given the deactivation magnet latency.