Intraoperative and perioperative complications with a vagus nerve stimulation device

Fahy, Brenda G.

doi:10.1016/j.jclinane.2009.10.002

Cited by 70 publications

(63 citation statements)

References 58 publications

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“…Nevertheless, disadvantages are related to intraoperative risks, such as lesions of the vagus nerve, or to infection, hoarseness, shortness of breath and the requirement for surgical intervention when the battery runs out [51][52][53]. Other respiratory complications may include vocal cord movement abnormalities, as well as sleep-related breathing pattern changes, with an associated increase in the number of obstructive apnoeas and hypopnoeas [54].…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Bari

Marchi

Maria

et al. 2016

Phil. Trans. R. Soc. A.

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Cardiovascular and cerebrovascular regulatory systems are vital control mechanisms responsible for guaranteeing homeostasis and are affected by respiration. This work proposes the investigation of cardiovascular and cerebrovascular control systems and the nonlinear influences of respiration on both regulations through joint symbolic analysis (JSA), conditioned or unconditioned on respiration. Interactions between cardiovascular and cerebrovascular regulatory systems were evaluated as well by performing correlation analysis between JSA indexes describing the two control systems. Heart period, systolic and mean arterial pressure, mean cerebral blood flow velocity and respiration were acquired on a beat-to-beat basis in 13 subjects experiencing recurrent syncope episodes (SYNC) and 13 healthy individuals (non-SYNC) in supine resting condition and during head-up tilt test at 60° (TILT). Results showed that JSA distinguished conditions and groups, whereas time domain parameters detected only the effect of TILT. Respiration affected cardiovascular and cerebrovascular regulatory systems in a nonlinear way and was able to modulate the interactions between the two control systems with different outcome in non-SYNC and SYNC groups, thus suggesting that the analysis of the impact of respiration on cardiovascular and cerebrovascular regulatory systems might improve our understanding of the mechanisms underpinning the development of postural-related syncope.

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Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Bari

Marchi

Maria

et al. 2016

Phil. Trans. R. Soc. A.

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“…Despite the therapeutic potential of VNS, adverse events associated with surgery and chronic stimulation limit broad applicability [23]. Importantly, the NTS, and spinal trigeminal nucleus (Sp5), also receive somatosensory afference via the auricular branch of the vagus nerve (ABVN) [36; 56].…”

Section: Introductionmentioning

confidence: 99%

Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients

García

Lin

Lee

et al. 2017

Pain

108

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Migraine pathophysiology includes altered brainstem excitability, and recent neuromodulatory approaches aimed at controlling migraine episodes have targeted key brainstem relay and modulatory nuclei. In this study, we evaluated the impact of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), a novel neuromodulatory intervention based on an existing transcutaneous Vagus Nerve Stimulation approach, in the modulation of brainstem activity and connectivity in migraine patients. We applied 3T-functional magnetic resonance imaging with improved in-plane spatial resolution (2.62×2.62 mm) in episodic migraine (interictal) and age- and sex-matched healthy controls to evaluate brain response to RAVANS (gated to either inhalation or exhalation) and sham stimulation. We further investigated RAVANS modulation of tactile trigeminal sensory afference response in the brainstem using air-puff stimulation directed to the forehead during functional magnetic resonance imaging. Compared to sham and inhalatory-gated RAVANS (iRAVANS), exhalatory-gated RAVANS (eRAVANS) activated an ipsilateral pontomedullary region consistent with nucleus tractus solitarii (NTS). During eRAVANS, NTS connectivity was increased to anterior insula and anterior mid-cingulate cortex, compared to both sham and iRAVANS, in migraine patients. Increased connectivity was inversely correlated with relative time to the next migraine attack, suggesting clinical relevance to this change in connectivity. Post-stimulation effects were also noted immediately following eRAVANS, as we found increased activation in putative pontine serotonergic (i.e. nucleus raphe centralis) and noradrenergic (i.e. locus coeruleus) nuclei in response to trigeminal sensory afference. Regulation of activity and connectivity of brainstem and cortical regions involved in serotonergic and noradrenergic regulation and pain modulation may constitute an underlying mechanism supporting beneficial clinical outcomes for eRAVANS applied for episodic migraine.

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“…Other contemporary forms of neurostimulation (aimed at induced neuromodulation) are invasive, expensive and have the potential for adverse effects. For example, deep brain stimulation and vagus nerve stimulation, which use implanted pacemaker-like electrical devices, are indicated for decreasing tremors in MS, but carry surgical risks [30-33]. These therapies have not been widely attempted in MS rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial

Tyler

Kaczmarek

Rust

et al. 2014

J NeuroEngineering Rehabil

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BackgroundThis study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain.MethodsThe study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI).ResultsThe DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean.ConclusionPeople with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.

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Intraoperative and perioperative complications with a vagus nerve stimulation device

Cited by 70 publications

References 58 publications

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients

Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial

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