Management of vagus nerve stimulation therapy in the peri-operative period: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists.

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.

Significant reduction in alcohol-related admissions to an intensive care unit in Dublin.

BACKGROUND: In 2008, we conducted an audit in our general intensive care unit (ICU) which demonstrated a high workload from alcohol-related admissions which represented 12 % of total admissions and 16.8 % of total available bed days at that time. AIMS: To repeat the audit 5 years later in 2013 to assess the current workload from alcohol-related admissions and whether this had increased or decreased in the intervening time period. METHODS: We retrospectively collected data from every admission to our 17-bed general ICU for the 6-month period from June 1 2013 to November 30 2013. We identified all admissions that were related to alcohol misuse. Their admission diagnosis, age, gender, ICU length of stay, APACHE 2 score (Acute Physiology and Chronic Health Evaluation 2) and 30-day mortality were recorded. The results of the 2013 audit were then compared with data from the 2008 study. RESULTS: There were 30 % less alcohol-related admissions to our ICU in 2013 compared to the same period in 2008. The study group had a longer length of stay on average but a lower mortality than the control group. CONCLUSION: There has been a significant reduction in the ICU workload from alcohol-related admissions in our general ICU in the past 5 years.