A near catastrophe from trigeminocardiac reflex

Abstract

Trigeminocardiac reflex is a brainstem reflex that results from stimulation of any branch of the trigeminal nerve along its course. It produces a constellation of signs and symptoms decrease in blood pressure (BP) and heart rate, dysrhythmias, apnoea and increased gastric motility. We present a case of 80-year-old female patient who developed alarming hypotension and bradycardia during craniotomy for meningioma excision resulting from this reflex. In the face of refractory hypotension despite administering ephedrine and phenylephrine, we had to resort to adrenaline to restore her normal BP.

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“…[8] Even though the duration and size of the haemodynamic disturbance may vary from one patient to another, and also on the type and location of stimulus, catastrophic consequences may result from this seemingly benign condition. [6,[9][10][11][12] Adequate precaution for the commonly accepted triggers of TCR such as hypercarbia, hypoxia, inadequate depth of anaesthesia, pain and acidosis is crucial. More importantly, a good communication between the neurosurgeon informing the neuro-anaesthesiologist of the anatomic proximity to vital structures (including the trigeminal nerve) and prompt reciprocation by the Trigeminocardiac reflex (TCR) is a unique autonomic brainstem reflex that manifests as sudden cardiac dysrhythmia (bradycardia), hypotension and gastric hypermotility because of the stimulation of the trigeminal nerve or any of its branches.…”