Perioperative Management and Anaesthetic Considerations in Vagal Nerve Stimulators’ Implantation in Refractory Epilepsy: First Case Series from Pakistan

This case series reports the first-ever successful implantation of vagal nerve stimulators (VNS) for refractory epilepsy in this region. It details the anaesthetic management of two patients who underwent VNS implantation, both of whom achieved positive outcomes with stable postoperative recovery. Comprehensive preoperative evaluations were conducted by the anaesthesia and neurosurgery teams. American Society of Anesthesiologists (ASA) II standard monitoring was employed without invasive lines, and intraoperative analgesia was managed with systemic agents. Anaesthesia played a key role in ensuring cardiovascular stability and a proactive approach to managing potential bradycardia. Both patients remained pain-free and haemodynamically stable throughout the procedure and during the initiation of vagal nerve stimulation. Postoperatively, patients experienced effective pain control, reduced nausea and vomiting, and shorter hospital stays. This case series highlights a significant advancement in our region’s anaesthetic and surgical capabilities, contributing to the learning and expertise required for future VNS procedures.