205:
220:) through various mechanisms. The longest nerve in the body, the vagus nerve serves both motor and sensory functions through afferent and efferent signaling to and from the brain. The vagus nerve releases the neurotransmitter acetylcholine, and is a main mediator for the parasympathetic nervous system.
97:
Vagal maneuvers are the first-line treatment of hemodynamically stable supraventricular tachycardia, serving to slow down or terminate the arrhythmia. Vagal maneuvers have a reported success rate of conversion to sinus rhythm for SVT around 20-40%, possibly being higher for AVNRT (an SVT associated
128:
While many physical maneuvers can elicit autonomic responses, only some are appropriate for use in a clinical setting. The vagal maneuvers most often used for diagnostic or therapeutic purposes are those that can be reliably performed at bedside or in an office setting with minimal risk. A list of
231:
and dividing many times to influence multiple organ systems and directly innervating the pharynx, larynx, esophagus, heart, lung, and GI tract. Due to this wide nerve distribution, many physiologic process may be influenced through its stimulation, including heart rate and blood pressure.
376:"2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society"
373:
Page, Richard L.; Joglar, José A.; Caldwell, Mary A.; Calkins, Hugh; Conti, Jamie B.; Deal, Barbara J.; Estes, N. A. Mark; Field, Michael E.; Goldberger, Zachary D.; Hammill, Stephen C.; Indik, Julia H. (5 April 2016).
254:) and utilizing those afferent nerve fibers to increase nerve activity. This results in increased parasympathetic signaling through its efferent distribution and is mediated by the chemical messenger acetylcholine.
800:
98:
with a bypass tract). Whereas the modified
Valsalva maneuver is most effective in adults, cold water immersion may be preferred as a safe, effective, and non-invasive treatment for pediatric SVT.
686:"Evaluation of efficacy of Valsalva for attenuating needle puncture pain in first time nonremunerated voluntary plateletpheresis donors: A prospective, randomized controlled trial"
907:
Nemeroff, Charles B.; Mayberg, Helen S.; Krahl, Scott E.; McNamara, James; Frazer, Alan; Henry, Thomas R.; George, Mark S.; Charney, Dennis S.; Brannan, Stephen K. (July 2006).
235:
Stimulation of the vagus nerve through vagal maneuvers is thought to effect afferent fibers that carry sensory information from its distribution throughout the body to the
684:
Srivastava, Anubha; Kumar, Sanjay; Agarwal, Anil; Khetan, Dheeraj; Katharia, Rahul; Mishra, Prabhaker; Khati, Shikha; Gautam, Sujeet; Sandeep, Khuba (1 January 2021).
239:(NTS) in the dorsal medullary complex, where it is then relayed to other areas of the brain. This stimulation can also be done more directly through a therapy called
243:, which utilizes an implanted neuro-stimulator device and is approved clinically for controlling seizures in epilepsy patients and drug resistant depression.
685:
745:"Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study"
31:
and helps regulate many critical aspects of human physiology, including heart rate, blood pressure, sweating, and digestion through the release of
111:
Vagal maneuvers may decrease temporary pain through sinoaortic baroreceptor mediated anti-nociception (inhibition of pain conduction, release of
162:
Other less clinically useful physical maneuvers that elicit a similar autonomic response through stimulation of the vagus nerve include:
455:"Initial and Sustained Response Effects of 3 Vagal Maneuvers in Supraventricular Tachycardia: A Randomized, Clinical Trial"
970:
246:
Vagal maneuvers make use of the vagus nerve's afferent and efferent bifunctional role, triggering reflexes (like the
743:
Kumar, Sanjay; Khuba, Sandeep; Agarwal, Anil; Gautam, Sujeet; Yadav, Madhulika; Dixit, Aanchal (December 2018).
86:
326:
Pasquier, Mathieu; Clair, Mathieu; Pruvot, Etienne; Hugli, Olivier; Carron, Pierre-Nicolas (12 October 2017).
67:
51:
There are both diagnostic and therapeutic indications for the use of vagal maneuvers in clinical practice.
909:"VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms"
272:
454:
28:
240:
142:
63:
509:
453:
Ceylan, Ezgi; Ozpolat, Cigdem; Onur, Ozge; Akoglu, Haldun; Denizbasi, Arzu (1 September 2019).
193:
510:"BET 2: Ice water immersion, other vagal manoeuvres or adenosine for SVT in children: Table 2"
75:
975:
251:
204:
8:
985:
155:
101:
Vagal maneuvers may be used to terminate hemodynamically stable ventricular tachycardia.
980:
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133:
59:
36:
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273:"Usefulness of Tilt Testing and Carotid Sinus Massage for Evaluating Reflex Syncope"
23:
is an action used to stimulate the parasympathetic nervous system by activating the
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224:
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71:
429:
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228:
116:
964:
934:
827:"Vagus nerve stimulation alters regional acetylcholine turnover in rat heart"
768:
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637:
588:
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478:
401:
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296:
148:
138:
82:
40:
32:
843:
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327:
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925:
908:
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786:
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729:
610:
Hess, D. S.; Hanlon, T.; Scheinman, M.; Budge, R.; Desai, J. (March 1982).
564:
541:
486:
439:
409:
359:
343:
304:
852:
645:
596:
213:
112:
24:
247:
16:
Action used to slow down the heart rate by stimulating the vagus nerve
271:
Rivasi, Giulia; Rafanelli, Martina; Ungar, Andrea (1 August 2018).
612:"Termination of ventricular tachycardia by carotid sinus massage"
825:
Lund, D D; Oda, R P; Pardini, B J; Schmid, P G (1 March 1986).
105:
104:
Various vagal maneuvers are suggested for the elimination of
35:. Common maneuvers that activate the vagus nerve include the
906:
683:
563:
Wei, J. Y.; Greene, H. L.; Weisfeldt, M. L. (January 1980).
208:
Parasympathetic nervous system mediated by vagal innervation
565:"Cough-facilitated conversion of ventricular tachycardia"
372:
609:
508:
Campbell, Marion; Buitrago, Silvia Ruiz (January 2017).
325:
742:
452:
43:, which can serve diagnostic or therapeutic functions.
428:
Niehues, Logan J.; Klovenski, Victoria (9 July 2021).
824:
270:
562:
962:
507:
427:
882:, Treasure Island (FL): StatPearls Publishing,
876:"Neuroanatomy, Cranial Nerve 10 (Vagus Nerve)"
27:. The vagus nerve is the longest nerve of the
156:oculocardiac reflex or Aschner-Dagnini reflex
873:
223:The vagus nerve exits the skull through the
123:
924:
842:
776:
719:
701:
627:
391:
70:by slowing the rate of conduction at the
874:Kenny, Brian J.; Bordoni, Bruno (2021),
203:
212:Vagal maneuvers serve to stimulate the
46:
963:
62:) can be used to distinguish between
690:Asian Journal of Transfusion Science
423:
421:
419:
154:Eyeball pressure (also known as the
332:The New England Journal of Medicine
58:Vagal maneuvers (most commonly the
13:
569:The American Journal of Cardiology
277:The American Journal of Cardiology
129:vagal maneuvers are listed below:
14:
997:
416:
749:Korean Journal of Anesthesiology
900:
867:
818:
793:
736:
677:
184:Intracardiac catheter placement
81:Vagal maneuvers (most commonly
652:
603:
556:
501:
471:10.1016/j.jemermed.2019.06.008
446:
366:
319:
264:
87:carotid sinus hypersensitivity
1:
526:10.1136/emermed-2016-206487.2
459:Journal of Emergency Medicine
289:10.1016/j.amjcard.2018.04.033
257:
241:Vagus Nerve Stimulation (VNS)
199:
581:10.1016/0002-9149(80)90235-0
393:10.1161/CIR.0000000000000311
68:supraventricular tachycardia
7:
10:
1002:
514:Emergency Medicine Journal
227:, moving down through the
187:Nasogastric tube placement
971:Cardiovascular physiology
434:. StatPearls Publishing.
237:nucleus tractus solitarii
124:Types of vagal maneuvers
29:autonomic nervous system
913:Neuropsychopharmacology
844:10.1161/01.RES.58.3.372
703:10.4103/ajts.AJTS_95_20
629:10.1161/01.cir.65.3.627
328:"Carotid Sinus Massage"
169:Gagging and/or vomiting
85:) are used to diagnose
64:ventricular tachycardia
926:10.1038/sj.npp.1301082
761:10.4097/kja.d.18.00017
344:10.1056/NEJMvcm1313338
209:
194:Trendelenburg position
147:Cold water immersion (
207:
139:Carotid sinus massage
83:carotid sinus massage
41:carotid sinus massage
831:Circulation Research
252:chemoreceptor reflex
47:Clinical indications
248:baroreceptor reflex
143:Czermak–Hering test
210:
181:Rectal examination
178:Deep respirations
134:Valsalva maneuver
60:Valsalva maneuver
37:Valsalva maneuver
993:
955:
954:
928:
919:(7): 1345–1355.
904:
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865:
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846:
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813:
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805:www.uptodate.com
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664:www.uptodate.com
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386:(14): e506–574.
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324:
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225:jugular foramen
218:cranial nerve X
202:
126:
49:
17:
12:
11:
5:
999:
989:
988:
983:
978:
973:
957:
956:
899:
866:
837:(3): 372–377.
817:
792:
755:(6): 453–458.
735:
676:
651:
622:(3): 627–633.
602:
575:(1): 174–176.
555:
500:
465:(3): 299–305.
445:
431:Vagal Maneuver
415:
365:
318:
283:(3): 517–520.
262:
261:
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256:
229:carotid sheath
201:
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172:Breath holding
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136:
125:
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109:
102:
99:
91:
90:
79:
48:
45:
21:vagal maneuver
15:
9:
6:
4:
3:
2:
998:
987:
984:
982:
979:
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149:diving reflex
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132:
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118:
117:noradrenaline
114:
110:
107:
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100:
96:
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93:Therapeutic:
88:
84:
80:
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73:
69:
65:
61:
57:
56:
55:
52:
44:
42:
38:
34:
33:acetylcholine
30:
26:
22:
916:
912:
902:
891:, retrieved
879:
869:
834:
830:
820:
808:. Retrieved
804:
795:
752:
748:
738:
696:(1): 68–74.
693:
689:
679:
667:. Retrieved
663:
654:
619:
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572:
568:
558:
520:(1): 58–60.
517:
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161:
127:
92:
54:Diagnostic:
53:
50:
20:
18:
976:Vagus nerve
893:11 November
810:11 November
669:11 November
616:Circulation
380:Circulation
338:(15): e21.
214:vagus nerve
113:substance P
25:vagus nerve
986:Cardiology
965:Categories
880:StatPearls
801:"UpToDate"
660:"UpToDate"
258:References
200:Physiology
175:Swallowing
981:Neurology
935:1740-634X
769:2005-6419
712:0973-6247
638:0009-7322
589:0002-9149
534:1472-0205
495:201631721
479:0736-4679
402:1524-4539
352:1533-4406
297:0002-9149
190:Squatting
951:11455427
943:16641939
888:30725856
861:17017695
787:29843507
730:34349460
550:29012408
542:27974431
487:31443919
440:31855402
410:26399663
360:29020587
313:49597948
305:29954601
166:Coughing
853:3719926
778:6283717
721:8294442
646:7055883
597:7350763
106:hiccups
949:
941:
933:
886:
859:
851:
785:
775:
767:
728:
718:
710:
644:
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485:
477:
438:
408:
400:
358:
350:
311:
303:
295:
78:nodes.
947:S2CID
857:S2CID
546:S2CID
491:S2CID
309:S2CID
939:PMID
931:ISSN
895:2021
884:PMID
849:PMID
812:2021
783:PMID
765:ISSN
726:PMID
708:ISSN
671:2021
642:PMID
634:ISSN
593:PMID
585:ISSN
538:PMID
530:ISSN
483:PMID
475:ISSN
436:PMID
406:PMID
398:ISSN
356:PMID
348:ISSN
301:PMID
293:ISSN
115:and
66:and
39:and
921:doi
839:doi
773:PMC
757:doi
716:PMC
698:doi
624:doi
577:doi
522:doi
467:doi
388:doi
384:133
340:doi
336:377
285:doi
281:122
141:or
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967::
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