Cardiac Emergencies in Neurosurgical Patients

Abstract

Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events.

The negative chronotropic effect during lumbar spine surgery

“…[1–10] On the other hand, hemodynamic perturbations in spine surgeries are limited to very few mechanisms including major bleeding, spinal shock, autonomic dysreflexia, parasympathetic nerve root activation, and venous air embolism. [1] Further to this, limited data exist related to hemodynamic changes during lumbar spine surgery [11–15] beyond the traumatic spinal cord injury. However, this gap in knowledge about hemodynamic perturbations during lumbar spine surgeries, and its clinical manifestation, similar to the neurosurgery well known TCR, suggests that there might also be a similar mechanism in the spinal as in the cerebral autonomous system.…”

Acute coronary spasm during posteriorfossa surgery and its successful management: A variable presentation of trigemino cardiac reflex

“…This is because the sympathetic fibers from carotid plexus lie on the medial side of the Gasserian ganglion. [5] In our case, the sudden hypertension was due to the sudden traction of the trigeminal nerve near the Meckel's cave. There was no further increase in heart rate noted during this event, possibly due to the administration of beta blockers before this event.…”

An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

“…The TCR involves stimulation of the trigeminal nerve or sensory branches, which leads to activation of the vagal motor nucleus and inhibition of the heart and systemic vascular system [ 1 , 14 ]. Placement of a stereotactic frame can elicit the TCR if a pin was erroneously placed on the supraorbital nerve [ 15 ].…”

“…Deep brain stimulation (DBS) has become a widely accepted therapy for adjustable, reversible modulation of brain function. Rare, but notable, intraoperative complications include critical hemodynamic instability, particularly symptomatic bradycardia and hypotension, which has been associated with venous air embolism [ 1 ]. To the authors' knowledge, there has been no occurrence linked to the Bezold-Jarisch reflex (BJR), a cardioinhibitory reflex that has been associated with states of hypovolemia.…”