Trigeminocardiac reflex: a unique case of recurrent asystole during bilateral trigeminal sensory root rhizotomy

Cha, Sang-Min; Eby, Joseph B.; Katzen, Janine; Shahinian, Hrayr K.

doi:10.1054/jcms.2001.0264

Cited by 62 publications

(43 citation statements)

References 18 publications

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“…A significant decrease in heart rate and blood pressure during surgical resection of tumor near the trigeminal nerve in the cerebellopontine angle has been reported [49,51], even in the pituitary fossa [48] and during balloon-compression rhizolysis of the trigeminal ganglion [14,49]. Several factors have been postulated as predisposing patients to the TCR based on cases of the OCR [9].…”

Section: Clinical Appearance Of Tcrmentioning

confidence: 99%

“…The trigemino-cardiac reflex (TCR) is a relatively unknown brainstem-reflex that has gained much attention to clinical medicine during recent years [14,50,51,56]. There is poor understanding of the underlying mechanism and functional relevance of this reflex response.…”

Section: Introductionmentioning

confidence: 99%

“…In the light of the increasing interest of TCR in clinical medicine, especially in skull base surgery [14,50,51,56] and in clinical electrophysiology, this seems to be the time to review the present knowledge and try to answer the question whether this reflex represents a physiological entity with defined anatomical and clinical correlation or is only a clinical phenomenon. Special attention will be given to the potential physiological functional relevance of the TCR.…”

Section: Introductionmentioning

confidence: 99%

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Trigeminocardiac reflex

2004

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The trigemino-cardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. The sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. This afferent pathway continues along the short internuncial nerve fibers in the reticular formatio to connect with the efferent pathway in the motor nucleus of the vagus nerve. Clinically, the trigemino-cardiac reflex has been reported to occur during craniofacial surgery, balloon-compression rhizolysis of the trigeminal ganglion, and tumor resection in the cerebellopontine angle. Apart from the few clinical reports, the physiological function of this brainstem-reflex has not yet been fully explored. From experimental findings, it may be suggested that the trigemino-cardiac reflex represents an expression of a central neurogenic reflex leading to rapid cerebrovascular vasodilatation generated from excitation of oxygen-sensitive neurons in the rostral ventrolateral medulla oblongata. By this physiological response, the adjustments of the systemic and cerebral circulations are initiated to divert blood to the brain or to increase blood flow within it. As it is generally accepted that the diving reflex and ischemic tolerance appear to involve at least partially similar physiological mechanisms, the existence of such endogenous neuroprotective strategies may extend the actually known clinical appearance of the TCR and include the prevention of other potentially brain injury states as well. This may be in line with the suggestion that the TCR is a physiological, but not a pathophysiological entity.

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Section: Clinical Appearance Of Tcrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trigeminocardiac reflex

2004

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“…The dysrhythmias may persist for as long as the stimulus is present, but have been shown to fatigue with repeated stimulation at short intervals. The critical period occurs during the fi rst few seconds after stimulation when bradycardia and cardiac depression are maximized [15] . Cardiac arrest may occur during this interval.…”

Section: Discussionmentioning

confidence: 99%

Delayed Trigeminocardiac Reflex Induced by an Intraorbital Foreign Body

Yılmaz

Erol²,

Yakar³

et al. 2005

Ophthalmologica

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Objective: To emphasize the importance of the mechanism and surgical approach to trigeminocardiac reflex (TCR) developing 48 h after orbital trauma due to a foreign body. Case Report: After gunshot injury of a 17-year-old male patient, computerized tomography evaluation revealed a right globe perforation and an intraorbital metallic foreign body in the right orbita adjacent to the lateral wall. The ocular perforation was repaired, but the foreign body was not removed. Constant bradycardia (45/min) developed 48 h after the operation. Since there were no cardiological findings, a temporary cardiac pacemaker was inserted and on the 6th postoperative day, the foreign body was removed through orbitolateral approach. After the removal of the foreign body, bradycardia completely recovered. Conclusion: In the presence of an intraorbital foreign body accompanied by globe perforation, TCR may develop 48 h after the trauma and insertion of a temporary pacemaker may be required to control the cardiac rhythm. In this paper, the delayed TCR complication presented an indication for the removal of the intraorbital foreign body.

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“…However, the period of time to reach the minimal heart rate decreases as tension applied increases [12,36]. Even intracranial manipulation of the trigeminal nerve is possible without inducing the reflex when this maneuver is performed gently [37]. Removing the triggering factor can cause cessation of the reflex, raising hemodynamic parameters to normal levels.…”

Section: Literature Review In Maxillofacial Surgerymentioning

confidence: 99%

Trigemino-Cardiac Reflex During Orbital Floor Reconstruction: A Case Report and Review

Vasudev¹,

Reddy

2011

J. Maxillofac. Oral Surg.

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Trigemino-cardiac reflex is occurrence of hypotension and bradycardia upon surgical manipulation of areas supplied by the trigeminal nerve, and has been reported during craniofacial maxillofacial and ocular surgeries. Communication between the anaesthetic and surgical team is essential, and cessation of the precipitating stimulus is the first and most important therapeutic step. We report a case of immediate, reproducible, and reflexive response of Bradycardia and dysrhythmia upon manipulation of orbital fracture during orbital floor reconstruction in a 65-year-old man. Upon recognition of the reproducible relationship between falcine stimulation and increased vagal tone, the patient was given atropine in an effort to block cholinergic hyperactivity. After atropine administration, no further dysrhythmias occurred and surgery was carried uneventfully.

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Trigeminocardiac reflex: a unique case of recurrent asystole during bilateral trigeminal sensory root rhizotomy

Cited by 62 publications

References 18 publications

Trigeminocardiac reflex

Trigeminocardiac reflex

Delayed Trigeminocardiac Reflex Induced by an Intraorbital Foreign Body

Trigemino-Cardiac Reflex During Orbital Floor Reconstruction: A Case Report and Review

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