The Trigemino-cardiac Reflex

Schaller, Bernhard; Cornelius, Jan F.; Prabhakar, Hemanshu; Koerbel, Andrei; Gnanalingham, Kanna; Sandu, Nora; Ottaviani, Giulia; Filis, Andreas; Buchfelder, Michael

doi:10.1097/ana.0b013e3181a2bf22

Cited by 177 publications

(118 citation statements)

References 76 publications

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“…Other, already known risk factors for the intraoperative occurrence of the TCR, like lighter plane of anaesthesia or drugs such as sufentanil, afentanil and calcium channel blockers could be excluded in these cases. It has already been shown in experimental and clinical situations that TCR could be initiated, independently of the kind of stimulation or of trigeminal nerve branches involved, 12,13 with a constant incidence from 8–18%. 12–14 Even so we have currently no exact incidence of the TCR initiation by intraoperative use of H 2 O 2 (around 3% in the present series), it could be assumed that it is lower, 12 giving rise to our previous hypothesis that more than one risk factor has to be present for initiating the TCR.…”

Section: Discussionmentioning

confidence: 99%

Use of Hydrogen Peroxide in Neurosurgery: Case Series of Cardiovascular Complications

et al. 2012

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ObjectivesPostoperative complications induced by hydrogen peroxide (H2O2) are described in the neurosurgical literature and mainly involve oxygen venous emboli, postoperative pneumocephalus; some of them even fatal. However, recently there are more and more published case reports for significant cardiac dysrhythmia related to the use of this chemical agent during routine neurosurgical interventions.DesignRetrospective, two-centre study.SettingRetrospective review of clinical/radiological documentation (including preoperative medical history, operation report and intraoperative anesthesiology data charts).ParticipantsPatients scheduled for cranial neurosurgical interventions.Main outcome measuresIntraoperative occurrence of trigeminocardiac reflex (TCR), according the earlier defined by our group criteria, or other severe cardiovascular complications related to the intraoperative use of H2O2.ResultsFive cases were included in the study fulfilling the strict inclusion/exclusion criteria. Two of the cases were recognized as intraoperative TCR, in the other three cases the cardiovascular effects were possibly due to TCR in one, mechanical stimulation of vital centre in anterior hypothalamus, brainstem, or either mechanical or thermal action of H2O2.ConclusionsAccording to this two-centre study, we can give, for the first time, evidence that cardiovascular complications according to the intraoperative use of H2O2 in neurosurgery are not rare with an incidence of 3%. Special reference is given to the occurrence of the TCR in this context.

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Section: Discussionmentioning

confidence: 99%

Use of Hydrogen Peroxide in Neurosurgery: Case Series of Cardiovascular Complications

et al. 2012

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“…Also, various subtypes of TCR show a difference in their reflex arc. While peripherally originated TCR is relayed via the spinal nucleus of the trigeminal nerve to the Kölliker–Fuse nucleus, the centrally originated TCR is conveyed via the nucleus of the solitary tract to the lateral parabrachial nucleus (35). …”

Section: Pathway Of Tcrmentioning

confidence: 99%

Sudden Infant Death Syndrome – Role of Trigeminocardiac Reflex: A Review

et al. 2016

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Sudden infant death syndrome (SIDS) is an unexplained death in infants, which usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR), is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex that manifests as bradycardia, hypotension, apnea, and gastric hypermotility. The TCR shares many similarities with the DR, which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath holding (apnea), bradycardia, and vasoconstriction, leading to increase in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation, or decreased neuronal density of arcuate nucleus, hypoplasia, and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field.

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“…Stimulation of trigeminal afferents produces apnea and strong reflex activation of cardiovagal activity and bradycardia [77–80]. The reflex is activated by exposure of the face to cold water during underwater diving, hence the term “ diving reflex.…”

Section: Reflex Control Of Cardiovagal Activity and Hrmentioning

confidence: 99%

Methods of assessing vagus nerve activity and reflexes

2010

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The methods used to assess cardiac parasympathetic (cardiovagal) activity and its effects on the heart in both humans and animal models are reviewed. Heart rate (HR)-based methods include measurements of the HR response to blockade of muscarinic cholinergic receptors (parasympathetic tone), beat-to-beat HR variability (HRV) (parasympathetic modulation), rate of post-exercise HR recovery (parasympathetic reactivation), and reflex-mediated changes in HR evoked by activation or inhibition of sensory (afferent) nerves. Sources of excitatory afferent input that increase cardiovagal activity and decrease HR include baroreceptors, chemoreceptors, trigeminal receptors, and subsets of cardiopulmonary receptors with vagal afferents. Sources of inhibitory afferent input include pulmonary stretch receptors with vagal afferents and subsets of visceral and somatic receptors with spinal afferents. The different methods used to assess cardiovagal control of the heart engage different mechanisms, and therefore provide unique and complementary insights into underlying physiology and pathophysiology. In addition, techniques for direct recording of cardiovagal nerve activity in animals; the use of decerebrate and in vitro preparations that avoid confounding effects of anesthesia; cardiovagal control of cardiac conduction, contractility, and refractoriness; and noncholinergic mechanisms are described. Advantages and limitations of the various methods are addressed, and future directions are proposed.

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The Trigemino-cardiac Reflex

Cited by 177 publications

References 76 publications

Use of Hydrogen Peroxide in Neurosurgery: Case Series of Cardiovascular Complications

Use of Hydrogen Peroxide in Neurosurgery: Case Series of Cardiovascular Complications

Sudden Infant Death Syndrome – Role of Trigeminocardiac Reflex: A Review

Methods of assessing vagus nerve activity and reflexes

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