Two Episodes of Trigeminocardiac Reflex During a Pan facial Fracture Surgery, a Rare Phenomenon – Case Report and Review of Literature

Abstract

A 40 year-old-male with a history of road traffic accident one week back was admitted in Kempegowda

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

“…The oculocardiac reflex is a subset of the trigeminocardiac reflex, involving only the ophthalmic branch of the trigeminal nerve, and it has been well described in strabismus surgery when the eye is retracted . Overstimulation of the maxillary branch of the trigeminal nerve (cranial nerve [CN] V2) leading to TCR can occur with craniofacial surgeries, such as Le Fort I osteotomies, midface fracture plating, and zygomatic arch fracture reduction . Sinus surgery can also induce TCR, as CN V2 innervates the nasal passages and cavernous sinus wall .…”

“…1 Overstimulation of the maxillary branch of the trigeminal nerve (cranial nerve [CN] V2) leading to TCR can occur with craniofacial surgeries, such as Le Fort I osteotomies, midface fracture plating, and zygomatic arch fracture reduction. 4,11 Sinus surgery can also induce TCR, as CN V2 innervates the nasal passages and cavernous sinus wall. 3,6 Temporomandibular joint arthroscopy or manipulation of the mandibular condyle during fracture repair can lead to TCR due to overstimulation of the auriculotemporal nerve, a branch of the mandibular branch of CN V (CN V3).…”

“…Mechanical stretching, pressure, or movement of any of the three branches of the trigeminal nerve can lead to TCR intraoperatively. Common otolaryngology procedures associated with TCR include Le Fort I osteotomies, midface fracture plating, mandibular condyle manipulation, and skull base surgery . There is a theoretically increased risk of TCR in the pediatric population due to a higher baseline vagal tone in children, although there are few studies describing this phenomenon in children .…”

“…Common otolaryngology procedures associated with TCR include Le Fort I osteotomies, midface fracture plating, mandibular condyle manipulation, and skull base surgery. [3][4][5][6][7] There is a theoretically increased risk of TCR in the pediatric population due to a higher baseline vagal tone in children, although there are few studies describing this phenomenon in children. [8][9][10] This study presents two pediatric cases of TCR during mouth retraction in adenotonsillectomy surgery.…”

Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf

“…1 Trigeminocardiac reflex menyebabkan beragam manifestasi dari hipotensi hingga hipertensi, bradikardi hingga asistol, bradipnea hingga apneu dan perubahan motilitas lambung. [1][2][3][4][5][6][7][8][9][10][11][12] Terjadinya aritmia jantung yang tiba-tiba sampai henti jantung, hipotensi arteri, apnea dan hipermobilitas lambung sebagai manifestasi TCR, awalnya dijelaskan pada tahun 1870 oleh Kratschmer et al, setelah manipulasi mukosa hidung pada kucing dan kelinci dan disebut sebagai Kratschmer's reflex. Pada tahun 1908, Bernhard Aschner dan Guiseppe Dagnini mempresentasikan oculocardiac reflex (OCR) sehingga disebut juga fenomena Aschner-saat itu dianggap sebagai deskripsi awal dari subtipe TCR perifer yang mendapat perhatian luas dokter mata.…”