The negative chronotropic effect during lumbar spine surgery

Chowdhury, Tumul; Schaller, Bernhard

doi:10.1097/md.0000000000005436

Cited by 16 publications

(22 citation statements)

References 28 publications

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“…Chowdhury and Schaller ( 46 ) recently described, for the first time, the existence of an SCR during direct or indirect manipulation of the spinal dura during spinal surgery. The mechanical stretch of the spinal dura with its intrinsic and extrinsic innervation was considered the most potent provoking factor in inciting this reflex.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding new findings in categorization and definition criteria, but also with the more and more diverse TCR-related phenomena ( 46 , 55 – 57 ), it was evident, that the hitherto established definition of a strict 20% drop in HR and MABP was not suitable for all TCR types anymore. Current research leads to a more flexible working definition that is better adaptable to the now newly existent different TCR subtypes ( 22 , 23 , 31 , 58 , 59 ) and has helped to close this important gap in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update

et al. 2017

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BackgroundThe trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR in 1999, there is an ongoing discussion about a more emergent clinical definition. In this work, the author worked out an approach to such an improved definition.MethodsIn this study, a grounded theory approach was used. Literature about TCR was systematically identified through PubMed (MEDLINE), EMBASE (Ovid SP), and ISI Web of Sciences databases from 1/2005 until 8/2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. A grounded theory approach was used to analyze and interpret the data through a synthesis by the researcher’s perspectives, values, and positions.ResultsOut of the included studies, the authors formed available data to an update of the understanding of changes in hemodynamic parameters (HR and blood pressure) in a TCR. According to this update, an HR deceleration should be a constant observation to identify a TCR episode while a drop in blood pressure should probably not being fixed to a certain percentage of decrease.ConclusionThe here presented working definition improves our understanding of the TCR. It leads the way to a new understanding of the TCR for a proper clinical definition.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update

et al. 2017

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“…[4567] In a systemic review by Chowdhury and Schaller spinal-cardiac reflex, a new entity has been described for the negative chronotropic effects during lumbar spine surgery. [8] In almost all case scenarios, bradycardia was noted, but hypotension was less frequently reported. In our case cardiovascular changes reverted after withdrawal of the surgical stimulus over few minutes without any medication, while in the rest of the five cases, anticholinergic and sympathomimetic drugs were administered.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular changes and lumbar spine surgery: A neglected entity

2019

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Cardiovascular changes following lumbar spine surgeries in the prone position have been less commonly described. Here, we report a case of an elderly male patient undergoing lumbar spine decompression and transforaminal interbody fusion who developed multiple but transient episodes of hypotension and bradycardia. Anesthesiologist should be vigilant while monitoring such patients and should use invasive blood pressure monitoring if possible, so as to detect transient cardiovascular episodes which may progress and results in a dreadful outcome.

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“…Nevertheless, the TCR is classically divided into the central (proximal) subtype with an intracranial trigger point proximal the Gasserian ganglion; the peripheral (distal) subtype, caused by stimulation upon the extra-cranial course of the trigeminal nerve; and the Gasserian ganglion subtypes. [ 49 , 59 ] Latest research implies a different manifestation of the TCR, according to the neuroanatomic/neuroembryolic events leading to a new classification of 5 key trigger points [ 47 , 60 ] around the 5th cranial nerve. The new classification model contains a subdivision of the peripheral subtype into the very peripheral diving reflex and the already known peripheral TCR, likewise the central TCR is now subdivided into a central and a further brainstem TCR.…”

Section: Introductionmentioning

confidence: 99%

The clinical surrogate definition of the trigeminocardiac reflex

Meuwly¹,

Chowdhury

Gelpi

et al. 2017

Medicine

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Background:The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR 1999, there is an ongoing discussion about a more flexible than the existing clinical definition. Aim of this work was to create a clinical surrogate definition through a systematic review of the literature.Methods:In this meta-analysis study, literature about TCR occurrences was, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, systematically identified through various search engines including PubMed (Medline), Embase (Ovid SP), and ISI Web of Sciences databases from January 2005 to August 2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. We extracted detailed data about hemodynamic changes and searched for connections between arterial blood pressure (BP) and HR changes during such episodes.Results:Overall 45 studies harboring 57 patients were included in the study but only 32 patients showed sufficient data for final analyze. HR showed a nonlinear behavior with a “tipping point” phenomena that differs in variance from the central/peripheral (20–30% drop) to ganglion (40–49% drop). BP showed a linear behavior with a “central limit” phenomena not differing in variance in the whole subgroup (30–39% drop). An analyzation of the correlation between BP and HR showed a trend to a linear correlation.Conclusions:We can show for the first time that HR is the dominant variable in the TCR and present a new surrogate definition model. This model and the role of BP must be better investigated in further studies.

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The negative chronotropic effect during lumbar spine surgery

Cited by 16 publications

References 28 publications

Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update

Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update

Cardiovascular changes and lumbar spine surgery: A neglected entity

The clinical surrogate definition of the trigeminocardiac reflex

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