Hypoglossal Nerve Stimulator Placement

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 180 degrees
Time: 2-4 hours (long)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

ETT – the patient will be turned 180 degrees, so ensure there’s adequate extension on the circuit. Ensure the ETT is secured very well. The surgeon will have the neck and chin prepped and draped so there will be very little access to the airway.

Extubate Awake – Since the greater majority of these patients have a severe form of sleep apnea, it is best practice to wake the patient before extubating.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

This is a second line intervention for sleep apnea. The patient typically needs to fail CPAP usage in order to have this intervention prescribed.

The surgery places a stimulator on the hypoglossal nerve. The stimulator increases glossal tone during inspiration, which helps keep the airway open. The stimulator is user-programmed such that it can begin stimulation only after a designated period of time. This allows a period of time for patient to fall asleep as normal before stimulation begins.