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A proposed guideline for vagus nerve stimulator handling in palliative care and after death
Epilepsia ( IF 5.6 ) Pub Date : 2020-05-28 , DOI: 10.1111/epi.16553
Ghadd Alhajaj 1 , Jeffrey Atkinson 2 , Mark R Keezer 3, 4, 5 , Ana Nikolic 6, 7, 8 , Kenneth A Myers 1, 2, 9
Affiliation  

Vagus nerve stimulation (VNS) is often used for patients with drug‐resistant epilepsy. Although this intervention may improve seizure control and mood, a number of factors must be considered when patients with VNS near end of life. We reviewed relevant literature to create a proposed guideline for management of patients with VNS in palliative care and after death. VNS has multiple possible side effects, including cough and swallowing difficulties. For patients with neurologic disease in palliative care, such adverse effects can severely affect quality of life and increase the risk for complications such as aspiration pneumonia. Patients with VNS should be screened regularly for such side effects, and VNS parameters should be adjusted if they are identified. If a patient requires urgent cardiac resuscitation involving external defibrillation, the VNS should be interrogated immediately afterwards to evaluate its function. During defibrillation, paddles should be placed perpendicular to the VNS, and as far as possible away from it. The VNS can be acutely turned off by taping the magnet to the patient's chest, thereby preventing any possible interference with restoration of a normal heart rhythm. After death, any staff involved with handling the body should be notified that a VNS is in place. The device must be removed prior to cremation, as it can explode with high heat. If the cause of death is unclear, a full postmortem examination should be undertaken, per sudden unexpected death in epilepsy guidelines. If there is concern about device malfunction, the device should be returned to the manufacturer for evaluation.

中文翻译:

姑息治疗和死后迷走神经刺激器处理的拟议指南

迷走神经刺激(VNS)常用于耐药性癫痫患者。虽然这种干预可能会改善癫痫发作控制和情绪,但当 VNS 患者接近生命终点时,必须考虑许多因素。我们回顾了相关文献,为姑息治疗和死后 VNS 患者的管理制定了建议的指南。VNS 有多种可能的副作用,包括咳嗽和吞咽困难。对于接受姑息治疗的神经系统疾病患者,此类不良反应会严重影响生活质量并增加发生吸入性肺炎等并发症的风险。应定期筛查 VNS 患者的此类副作用,一旦发现应调整 VNS 参数。如果患者需要涉及体外除颤的紧急心脏复苏,之后应立即询问 VNS 以评估其功能。在除颤期间,桨应垂直于 VNS 放置,并尽可能远离 VNS。VNS 可以通过将磁铁贴在患者胸部上来迅速关闭,从而防止对恢复正常心律的任何可能干扰。死后,任何参与处理尸体的工作人员都应被告知 VNS 已就位。该装置必须在火化前移除,因为它会在高温下爆炸。如果死因不明,应根据癫痫指南中的突然意外死亡进行全面的尸检。如果担心设备出现故障,应将设备退回制造商进行评估。
更新日期:2020-05-28
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