Reference no: EM133574556
INDICATION FOR PROCEDURE: The patient is a 6-year-old child who was found to have progressive epilepsy. It was recommended that a vagal nerve stimulator be placed. We discussed the options, the risks, and benefits with the child's parents, and their questions were welcomed and answered. The procedure and potential risks of surgery include, but are not limited to, vagal nerve injury, vascular damage, stroke, inoperability, malfunction, the need for continuous monitoring and evaluations, the possible need for further surgical interventions, among others. With the family's understanding and permission, the child was brought to the operating room for this procedure.
DESCRIPTION OF PROCEDURE: After suitable general endotracheal anesthesia was obtained, the patient was placed in the supine position and the head immobilized in a donut. The skin was prepared using Betadine scrub and solution and a suitable surgical drape. Marcaine with epinephrine was infiltrated.
Initially, we made a 2.5 cm incision along the neck crease, and the platysma muscle was divided. The sternocleidomastoid muscle was retracted and dissected medially, and we identified the carotid sheath. The carotid sheath was opened and we identified the vagal nerve. This was then isolated with vessel loops.
We then attached the two electrodes in the grounding mechanism using 2 mm size coils. These were found to be securely placed and a small loop was left for anchoring.
We then prepared the pocket while making a 6 cm curvilinear incision just medial to the axilla. A subcutaneous pocket was created over the pectoralis muscle, and the area was irrigated.
We then used the tunneling device from the cervical to the chest incisions, and the electrodes were placed in the subcutaneous tunnel. The model 102 generator was then connected to the electrodes. An impedance test was done and was found to be 1.
The electrode in the subclavian was left with a small loop for growth, and this was anchored to the fascia using a Vicryl suture.
Subsequently, the generator was turned on at the 0.25 mA at 30 Hz, on 30 seconds, off for 5 minutes, with a magnet strength of 0.5 for 60 seconds.
The wounds were then irrigated and subsequently painted with Betadine solution. They were then closed using 3-0 Vicryl sutures for the deep layer. The skin was approximated using 4-0 Vicryl suture in a running subcuticular fashion. Steri-Strips were applied, and the patient was awakened and transported to the recovery room, having tolerated the procedure well.
We discussed the operation, the findings, and the potential implications and complications with the patient's family. Their questions were welcomed and answered, and they expressed understanding of the situation.
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