Trigeminocardiac reflex in pediatric adenotonsillectomy: A report of two cases with literature review

Abstract

Trigeminocardiac reflex (TCR) is a physiological response that occurs due to stimulation of the trigeminal nerve, resulting in vagus nerve activation, parasympathetic dysrhythmia, and sympathetic hypotension. The pediatric population is vulnerable to TCR due to higher resting vagal tone, which can result in ischemia and death. This study reports two cases of TCR during adenotonsillectomy. Placement and rapid opening of a Crowe‐Davis retractor led to immediate bradycardia and hypotension in two children undergoing adenotonsillectomy, which resolved upon release of the retractor. Early intraoperative recognition of TCR with removal of mechanical stimulation can resolve vital instability without need for chemical intervention. Laryngoscope, 130:803–805, 2020

In Response to Letter to the Editor Regarding: Trigeminocardiac Reflex in Pediatric Adenotonsillectomy: A Report of Two Cases With Literature Review

“…TCR is currently a clinical diagnosis, and specific criteria have been proposed to confirm its cause-and-effect cascade. 1 Major diagnostic criteria include plausibility and reversibility, that is, the appearance of TCR may be explainable by adequate trigeminal nerve stimulation; TCR occurs promptly after the stimulus is applied; and cessation of the stimulus resolves the vagal response. 2 Both patients described in our case series meet these major criteria for TCR diagnosis.…”

“…However, this task may be logistically difficult because TCR does not occur with all forms of trigeminal nerve stimulation but rather only with rapid compression or stretching of the nerve. 1 Concurrent IONM monitoring the trigeminal nerve and the vagus nerve may yield a better cause-effect association, although selective monitoring of the parasympathetic fibers of the vagus nerve may be challenging. The ethical concerns of inducing TCR solely for diagnostic purposes must be addressed, and the costs of using of IONM in routine adenotonsillectomies to potentially capture TCR must be considered.…”

“…We would like to thank Dr. Karhtikeyan et al for their assessment of our work regarding the trigeminocardiac reflex (TCR) 1 in children during adenotonsillectomy surgery. We would like to address their comments regarding the TCR pathway and its diagnosis.…”

Regarding Trigeminocardiac Reflex in Paediatric Adenotonsillectomy: A Report of Two Cases With Literature Review

“…

We came across this very interesting and thoughtprovoking article, titled "Trigeminocardiac Reflex in Paediatric Adenotonsillectomy: A Report of Two Cases With Literature Review," by Li et al 1 in your esteemed journal. It is well written, and we appreciate the authors' on their remarkable efforts for having explored this area of trigeminocardiac reflex (TCR), which still remains an area that demands more research.We would like to bring in few more points on TCR, which we hope will be of added value to this well-written article.

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