Case report: 2 cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endonasal transsphenoidal endoscopic pituitary surgery

Abstract

Background Trigeminal-cardiac reflex (TCR) is a brainstem vagus reflex that occurs when any center or peripheral branch of the trigeminal nerve was stimulated or operated on. The typical clinical manifestation is sudden bradycardia with or without blood pressure decline. The rhino-cardiac reflex which is one type of TCR is rare in clinical practice. As the rhino-cardiac reflex caused by disinfection of the nasal cavity is very rare, we report these two cases to remind other anesthesiologists to be vigilant to this situation. Case presentation This case report describes two cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endoscopic transsphenoidal removal of pituitary adenomas. Their heart rate all dropped suddenly at the very moment of nasal stimulation and recovered quickly after stimulation was stopped and the administration of drugs or cardiac support. Conclusion Although the occurrence of rhino-cardiac reflex is rare, we should pay attention to it in clinical anesthesia. It is necessary to know the risk factors for preventing it. Once it occurs, we should take active and effective rescue measures to avoid serious complications.

Neurally Mediated Syncope Triggered by COVID-19 Nasopharyngeal Swab Specimen Collection: A Case Report

“…Of concern, there are reports of cardiac arrest induced by the activation of the nasal-cardiac reflex. 10 A recent case report described an episode of asystole during nasopharyngeal swab specimen collection for COVID-19 testing. 11 Unlike the healthy patient we presented, the patient in the aforementioned report was sedated and ventilated while inpatient for complicated COVID-19 infection, which itself has been associated with syncope.…”

Antiseptic drugs and disinfectants with experience of the second year of COVID-19 pandemic-related side effects

“…Cardiovascular : Two cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting the nasal cavity before endonasal surgery were described in a 66-year-old and a 37-year-old man. In both cases, iodophor disinfectants (unspecified type and concentration) were dripped into the nasal cavities of the patients ( Wang, Cai, et al, 2021 ) [A].…”