Delayed trigeminocardiac reflex after maxillofacial surgery: case report

Guedes, Alexandre Almeida; Pereira, Felipe Ladeira; Machado, Eric Guimarães; Filho, Marcello Fonseca Salgado; Chaves, Leandro Fellet Miranda; Araújo, Fernando de Paiva

doi:10.1016/j.bjane.2018.12.001

Cited by 4 publications

(8 citation statements)

References 4 publications

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“…The age group of 31-45 was thought to be more susceptible to develop TCR due to high vagal tone and increase in the level of anxiety of the patients in this particular age group. It was also suggested by Guedes et al that TCR can be observed 24 hours after the procedure, but as the heart rate and blood pressure were not recorded beyond the intraoperative hours, we could not assess if TCR can occur as a delayed reflex [ 10 ]. Though the literature shows many studies showing the TCR, the actual pathophysiology is still unclear, and hence more studies need to be done to clearly understand this phenomenon [ 11 - 14 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Mhamunkar¹,

Kolari²,

Sequeira³

2022

Cureus

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Aim Trigeminocardiac reflex (TCR) manifests as typical hemodynamic perturbations including a sudden lowering of heart rate, mean arterial blood pressure (MABP), cardiac arrhythmias, and asystole. In literature, TCR has been seen during ocular surgeries, Lefort fractures, and craniofacial surgeries. However, the prevalence of the TCR has not been studied in zygomatic complex fractures . The aim of this study was to assess the prevalence of TCR in patients undergoing elevation with/without fixation of zygomatic complex fractures and isolated zygomatic arch fractures under local anesthesia and general anesthesia and to evaluate the prevalence of TCR in different age groups. Materials and methods The study comprised 26 participants diagnosed with zygomatic fractures indicated for surgical intervention. The aim of the study was to find the prevalence of TCR in patients undergoing surgical intervention (elevation of zygomatic complex fractures with/without fixation) under local anesthesia and general anesthesia. The heart rate and blood pressure were measured preoperatively, intraoperatively and postoperatively. Results Variation in heart rate was seen in patients undergoing surgery under local anesthesia and general anesthesia. However, a decrease in the heart rate i.e., bradycardia was noted intra-operatively in 75% of the patients operated under local anesthesia. The prevalence of TCR was noted intra-operatively in 23% of cases operated under general anesthesia. No significant changes were seen in the blood pressure of the patients. Conclusion In our study, we found out that the prevalence of TCR was more in the patients operated under local anesthesia i.e., 75% of patients. Out of the patients operated under general anesthesia i.e., 23% of patients showed TCR. No significant variations in blood pressure were observed in patients operated under local anesthesia or general anesthesia. The prevalence of TCR was found more often in the age group of 31-45 years in our study.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Mhamunkar¹,

Kolari²,

Sequeira³

2022

Cureus

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“…Although most documented cases of TCR have been intra-operative occurrences, there have been reports of delayed TCR following maxillofacial surgery in the post-operative period. A patient who underwent an uneventful zygomatic-orbital complex surgery and nasal bone fracture reduction with placement of nasal packings bilaterally was transferred to the Post-Anesthesia Care Unit (PACU) where he developed dyspnea, bradycardia, hypotension, and hypoxemia [ 5 ]. After no improvement with 100% O 2 administration, atropine was administered, which corrected only the bradycardia.…”

Section: Introductionmentioning

confidence: 99%

“…After no improvement with 100% O 2 administration, atropine was administered, which corrected only the bradycardia. TCR was suspected, and the bilateral nasal packings placed in the operating room were removed, with complete resolution of signs and symptoms within 5 minutes [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Trigeminocardiac Reflex Induced by Maxillary Nerve Stimulation during Sphenopalatine Ganglion Implantation: A Case Series

et al. 2020

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Background: The trigeminocardiac reflex (TCR) is a brainstem reflex following stimulation of the trigeminal nerve, resulting in bradycardia, asystole and hypotension. It has been described in maxillofacial and craniofacial surgeries. This case series highlights TCR events occurring during sphenopalatine ganglion (SPJ) neurostimulator implantation as part of the Pathway CH-2 clinical trial “Sphenopalatine ganglion Stimulation for Treatment of Chronic Cluster Headache”. Methods: This is a case series discussing sphenopalatine ganglion neurostimulator implantation in the pterygopalatine fossa as treatment for intractable cluster headaches. Eight cases are discussed with three demonstrating TCR events. All cases received remifentanil and desflurane for anesthetic maintenance. Results: Each patient with a TCR event experienced severe bradycardia. In two cases, TCR resolved with removal of the introducer, while the third case’s TCR event resolved with both anticholinergic treatment and surgical stimulation cessation. Conclusion: Each TCR event occurred before stimulation of the fixed introducer device, suggesting the cause for the TCR events was mechanical in origin. Due to heightened concern for further TCR events, all subsequent cases had pre-anesthesia external pacing pads placed. Resolution can occur with cessation of surgical manipulation and/or anticholinergic treatment. Management of TCR events requires communication between surgical teams and anesthesia providers, especially during sphenopalatine ganglion implantation when maxillary nerve stimulation is possible.

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“…Most publications thus far have fallen under pediatrics, neurosurgery, and anesthesia. 11–31 Importantly, despite clear links to procedures practiced daily, there has been little research within otolaryngology, dermatologic, and oculoplastic surgery. 3,5,20,22,32,33…”

mentioning

confidence: 99%

“…11–31 Importantly, despite clear links to procedures practiced daily, there has been little research within otolaryngology, dermatologic, and oculoplastic surgery. 3,5,20,22,32,33…”

mentioning

confidence: 99%

Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery

Poe

Bosley²,

Steele³

et al. 2023

Dermatol Surg

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BACKGROUNDThe trigeminocardiac reflex is a common but underreported occurrence that can vary from benign to life threatening. This reflex can be elicited by placing direct pressure on the globe of the eye or from traction of the extraocular muscles, stimulating the trigeminal nerve.OBJECTIVETo provide a review of potential stimuli for the trigeminocardiac reflex within dermatologic surgery and to discuss management options for the treatment of the trigeminocardiac reflex.METHODSPubMed and Cochrane were used to identify articles and case reports that established scenarios in which the trigeminocardiac reflex was provoked and subsequently how the reflex was managed.RESULTSWithin the field of dermatologic surgery, the trigeminocardiac reflex can be stimulated during biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions, most often occurring in an office setting. The most common presentations include significant bradycardia, hypotension, gastric hypermobility, and lightheadedness. The most definitive treatment is cessation of the inciting stimulus, monitoring, and symptomatic management. Glycopyrrolate and atropine are common treatments for severe, intractable cases of the trigeminocardiac reflex.CONCLUSIONThe trigeminocardiac reflex, while underreported and underrepresented in dermatologic literature and dermatologic surgery settings, should be considered in the setting of bradycardia and hypotension during dermatologic procedures.

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Delayed trigeminocardiac reflex after maxillofacial surgery: case report

Cited by 4 publications

References 4 publications

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Trigeminocardiac Reflex Induced by Maxillary Nerve Stimulation during Sphenopalatine Ganglion Implantation: A Case Series

Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery

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