Management of the trigeminocardiac reflex: Facts and own experience

Arasho, Belachew; Sandu, Nora; Spiriev, Toma; Prabhakar, Hemanshu; Schaller, Bernhard

doi:10.4103/0028-3886.55577

Cited by 109 publications

(44 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unresolved cases may necessitate the use of intravenous epinephrine (6 mcg). [7] Clear correlation does not exist between intraoperative TCR and postoperative outcome. Few case series have revealed a poor outcome of the surgery in which intraoperative TCR was observed.…”

Section: Discussionmentioning

confidence: 99%

Trigeminocardiac reflex preceding development of postoperative superior orbital fissure syndrome

et al. 2017

View full text Add to dashboard Cite

The superior orbital fissure syndrome (SOFS) is a rare condition presenting as painful unilateral opthalmoplegia, ptosis, pupillary dilatation and anesthesia of the upper eyelid and forehead. It has been described after facial trauma. Other etiologies include infections, tumors or spontaneous hemorrhages in the retro-orbital space. Occurrence of SOFS after surgery in the skull base has not been described before. We recently encountered a case where a young female developed SOFS following surgery for cerebrospinal fluid (CSF) rhinorrhea. The occurrence of SOFS was preceded by episodes of trigemino-cardiac reflex (TCR) during the surgery. This is the first case report associating TCR with SOFS. We managed the case report with megadose methylprednisolone and the patient showed improvement in the deficit over time.

show abstract

Section: Discussionmentioning

confidence: 99%

Trigeminocardiac reflex preceding development of postoperative superior orbital fissure syndrome

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Second-order neurons are located mostly lateral and slightly dorsal to the nucleus ambiguous in the ventral trigeminal nucleus. [1] The pathway continues from the ventral trigeminal nucleus through the short internuncial nerve fibers in the reticular formation in the brainstem and synapse on efferent cholinergic premotor parasympathetic cardio-inhibitory neurons in the nucleus ambiguous. [1]…”

Section: Discussionmentioning

confidence: 99%

“…[1] A direct stimulation of parasympathetic endings in or around the cavernous sinus may be prompted by compression or traction of the oculomotor nerve. Yet, there is controversy about the oculomotor nerve carrying afferent parasympathetic fibers at this location being able to induce TCR.…”

Section: Discussionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

Amirjamshidi

Etezadi²,

Ghasemi³

2013

Surg Neurol Int

View full text Add to dashboard Cite

Background:Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve are coined as trigeminocardiac reflex (TCR). Neither enough is known about the predisposing factors in relation with the intraoperative occurrence of this life threatening reflex, nor about the exact pathophysiology of its brain stem pathway.Encountering two cases of bradycardia and hypotension during surgery encouraged the authors to: (1) report these two cases and review similar reports in the relevant literature, (2) discuss the suggested mechanisms for such an event, and (3) report the result of a prospective cohort of precisely checked cases in a sister article, to remind the younger neurosurgical community of a possible and bothering even mortal, but avoidable complication in their everyday practice.Case Description:The first case was a 71-year-old male who developed bradycardia and hypotension while packing his large sella tursica with autologous fat after removing a large nonfunctional pituitary adenoma transsphenoidally to prevent cerebrospinal fluid leakage. The changes in his vital signs were detected and controlled rapidly.The second case was a 52-year-old female who underwent right pterional craniotomy for right clinoidal meningioma. She developed severe bradycardia and hypotension after skin closure completed and just when the subgaleal drain was connected to the aspirating bag and negative pressure maintained in the subgaleal region.Both cases could be managed successfully after on time detection of such life threatening complication and proper management.Conclusion:We do not intend only to add two new cases of TCR occurring in the perioperative period in neurosurgical practice, but we wish to raise the question: (a) what could be the predisposing factors for development of such issue for better handling of the problem and (b) stress upon careful continuous mapping of the vital signs during surgery and even till very late after operation.

show abstract

“…[924] Accordingly, TCR has been defined as any cardiac reflex triggered with stimulation of the trigeminal nerve anywhere throughout its central or peripheral course. [2] Those studying on oculo-cardiac reflex (OCR), regarded as an old subtype of TCR focusing on the HR only recalled it positive with a 10-20% decline in the HR coincident with the manipulation of the eye-related structures. [251026]…”

Section: Introductionmentioning

confidence: 99%

“…[2] Those studying on oculo-cardiac reflex (OCR), regarded as an old subtype of TCR focusing on the HR only recalled it positive with a 10-20% decline in the HR coincident with the manipulation of the eye-related structures. [251026]…”

Section: Introductionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Etezadi

Orandi²,

Orandi³

et al. 2013

Surg Neurol Int

View full text Add to dashboard Cite

Background:Considering wide variations regarding the incidence of trigeminocardiac reflex (TCR) during cranial neurosurgical procedures, and paucity of reliable data, we intended to design a prospective study to determine the incidence of TCR in patients undergoing standard general anesthesia for surgery of supra/infra-tentorial cranial and skull base lesions.Methods:A total of 190 consecutive patients candidate for elective surgery of supra-tentorial, infra-tentorial, and skull base lesions were enrolled. All the patients were operated in the neurosurgical operating room of a university-affiliated teaching hospital. All surgeries were performed using sufficient depth of anesthesia achieved by titration of propofol–alfentanil mixture, adjusted according to target Cerebral State Index (CSI) values (40-60). All episodes of bradycardia and hypotension indicating the occurrence of TCR during the surgery (sudden decrease of more than 20% from the previous level) were recorded.Results:Four patients, two female and two male, developed episodes of TCR during surgery (4/190; 2.1%). Three patients showed one episode of TCR just at the end of operation when the skin sutures were applied while CSI values were 70-77 and in the last case, when small tumor samples were taken from just beneath the lateral wall of the cavernous sinus TCR episode was seen while the CSI value was 51.Conclusion:TCR is a rare phenomenon during brain surgeries when patient is anesthetized using standard techniques. Keeping the adequate depth of anesthesia using CSI monitoring method may be an advisable strategy during whole period of a neurosurgical procedure.

show abstract

Management of the trigeminocardiac reflex: Facts and own experience

Cited by 109 publications

References 34 publications

Trigeminocardiac reflex preceding development of postoperative superior orbital fissure syndrome

Trigeminocardiac reflex preceding development of postoperative superior orbital fissure syndrome

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Contact Info

Product

Resources

About