scholarly journals Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf

2021 ◽  
Vol 10 (3) ◽  
pp. 214-227
Author(s):  
Dewi Yulianti Bisri ◽  
Keyword(s):  
Risk Factor ◽  
Trigeminal Nerve ◽  
Sudden Onset ◽  
Cardiovascular Monitoring ◽  
Trigeminocardiac Reflex ◽  
Brainstem Reflex ◽  
Surgical Conditions ◽  
And Function ◽  
Neurointerventional Procedures ◽  
Brain Stem Reflex

Trigeminocardiac reflex (TCR) is a unique brain stem reflex that manifests as negative cardio-respiratory perturbations. The trigeminocardiac 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. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. This reflex is largely reported in skull base surgeries/interventions; however, in recent times, it has been also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. If a CTR occurs, it can risk factor identification and modification, depth of anesthesia assessment, prophylactic treatment with either vagolytic agents or peripheral nerve block in case of peripheral manipulations of the nerve, careful cardiovascular monitoring during anesthesia, especially in those with a risk factor for TCR, treatment of the condition when it occurs: cessation of the manipulation, and administration of vagolytic agents and adrenaline. Therefore, this narrative review intends to elaborate on its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.

scholarly journals Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Shuhei Yamada ◽  
Yoshihiro Yano ◽  
Toshiaki Fujita ◽  
Mamoru Taneda
Keyword(s):  
Trigeminal Nerve ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cardiac Pacing ◽  
Poor Response ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Trigeminocardiac Reflex ◽  
Brainstem Reflex ◽  
First Case ◽  
Intravenous Atropine

BACKGROUND Trigeminocardiac reflex (TCR) is a brainstem reflex caused by stimulation of the trigeminal nerve, which results in bradycardia, hypotension, and asystole. TCR can occur during any neurosurgical procedure. Initially, it is managed via the immediate removal of the stimulus from the trigeminal nerve. If asystole persists after intravenous atropine or glycopyrrolate, chest compression or transcutaneous cardiac pacing may be considered. The authors present the first case of TCR that was successfully managed with transcutaneous cardiac pacing. OBSERVATIONS A 51-year-old man presented with aneurysmal subarachnoid hemorrhage. Although he had no history of cardiac disease and there were no abnormal findings on electrocardiography, transient asystole due to TCR occurred during craniotomy. The patient’s heart rate spontaneously recovered after the immediate discontinuation of the procedure. The authors completed aneurysm clipping with transcutaneous cardiac pacing because intravenous atropine was not effective in preventing TCR. There were no complications associated with intraoperative asystole or transcutaneous cardiac pacing, and the patient was discharged without neurological deficits. LESSONS TCR can be appropriately managed with the immediate discontinuation of intraoperative procedures. Furthermore, transcutaneous cardiac pacing may be considered for persistent TCR with poor response to intravenous atropine or glycopyrrolate.

scholarly journals Trigeminocardiac Reflex Induced by Maxillary Nerve Stimulation during Sphenopalatine Ganglion Implantation: A Case Series

2020 ◽  
Vol 10 (12) ◽  
pp. 973
Author(s):  
Yousef Hammad ◽  
Allison Mootz ◽  
Kevin Klein ◽  
John R. Zuniga
Keyword(s):  
Nerve Stimulation ◽  
Case Series ◽  
Chronic Cluster Headache ◽  
Sphenopalatine Ganglion ◽  
Trigeminocardiac Reflex ◽  
Maxillary Nerve ◽  
Brainstem Reflex ◽  
Surgical Teams ◽  
Cluster Headaches ◽  
Stimulation Of

Background: The trigeminocardiac reflex (TCR) is a brainstem reflex following stimulation of the trigeminal nerve, resulting in bradycardia, asystole and hypotension. It has been described in maxillofacial and craniofacial surgeries. This case series highlights TCR events occurring during sphenopalatine ganglion (SPJ) neurostimulator implantation as part of the Pathway CH-2 clinical trial “Sphenopalatine ganglion Stimulation for Treatment of Chronic Cluster Headache”. Methods: This is a case series discussing sphenopalatine ganglion neurostimulator implantation in the pterygopalatine fossa as treatment for intractable cluster headaches. Eight cases are discussed with three demonstrating TCR events. All cases received remifentanil and desflurane for anesthetic maintenance. Results: Each patient with a TCR event experienced severe bradycardia. In two cases, TCR resolved with removal of the introducer, while the third case’s TCR event resolved with both anticholinergic treatment and surgical stimulation cessation. Conclusion: Each TCR event occurred before stimulation of the fixed introducer device, suggesting the cause for the TCR events was mechanical in origin. Due to heightened concern for further TCR events, all subsequent cases had pre-anesthesia external pacing pads placed. Resolution can occur with cessation of surgical manipulation and/or anticholinergic treatment. Management of TCR events requires communication between surgical teams and anesthesia providers, especially during sphenopalatine ganglion implantation when maxillary nerve stimulation is possible.

scholarly journals Prenatal nicotine exposure enhances the trigeminocardiac reflex via serotonin receptor facilitation in brainstem pathways

2013 ◽  
Vol 115 (4) ◽  
pp. 415-421 ◽  
Author(s):  
C. Gorini ◽  
H. Jameson ◽  
A. L. Woerman ◽  
D. C. Perry ◽  
D. Mendelowitz
Keyword(s):  
Receptor Antagonist ◽  
Trigeminal Nerve ◽  
Serotonin Receptor ◽  
Nucleus Ambiguus ◽  
Nicotine Exposure ◽  
Sprague Dawley ◽  
Trigeminocardiac Reflex ◽  
Brainstem Slice ◽  
Prenatal Nicotine Exposure ◽  
Prenatal Nicotine

In this study we used a rat model for prenatal nicotine exposure to test whether clinically relevant concentrations of brain nicotine and cotinine are passed from dams exposed to nicotine to her pups, whether this changes the trigeminocardiac reflex (TCR), and whether serotonergic function in the TCR brainstem circuitry is altered. Pregnant Sprague-Dawley dams were exposed to 6 mg·kg−1·day−1of nicotine via osmotic minipumps for the duration of pregnancy. Following birth dams and pups were killed, blood was collected, and brain nicotine and cotinine levels were measured. A separate group of prenatal nicotine-exposed pups was used for electrophysiological recordings. A horizontal brainstem slice was obtained by carefully preserving the trigeminal nerve with fluorescent identification of cardiac vagal neurons (CVNs) in the nucleus ambiguus. Stimulation of the trigeminal nerve evoked excitatory postsynaptic current in CVNs. Our data demonstrate that prenatal nicotine exposure significantly exaggerates both the TCR-evoked changes in heart rate in conscious unrestrained pups, and the excitatory neurotransmission to CVNs upon trigeminal afferent nerve stimulation within this brainstem reflex circuit. Application of the 5-HT1Areceptor antagonist WAY 100635 (100 μM) and 5-HT2A/Creceptor antagonist ketanserin (10 μM)significantly decreased neurotransmission, indicating an increased facilitation of 5-HT function in prenatal nicotine-exposed animals. Prenatal nicotine exposure enhances activation of 5-HT receptors and exaggerates the trigeminocardiac reflex.

scholarly journals Trigeminocardiac reflex during surgery in the cerebellopontine angle

1998 ◽  
Vol 5 (3) ◽  
pp. E9 ◽  
Author(s):  
Bernhard Schall ◽  
Rudolf Probst ◽  
Stephan Strebel ◽  
Peter Fuhr ◽  
Otmar Gratzl
Keyword(s):  
Blood Pressure ◽  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Experimental Studies ◽  
Ocular Surgery ◽  
Trigeminocardiac Reflex ◽  
Arterial Blood ◽  
Nerve System ◽  
Central Stimulation ◽  
Stimulation Of

In different experimental studies authors have analyzed the autonomic responses elicited by the electrical, mechanical, or chemical stimulation of the trigeminal nerve system. The trigeminocardiac reflex (TCR) is a well-recognized phenomenon that consists of bradycardia, arterial hypotension, apnea, and gastric hypermotility. It occurs during ocular surgery and during other manipulations in and around the orbit. Thus far, it has not been shown that central stimulation of the trigeminal nerve can also cause this reflex. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) of more than 20% and bradycardia lower than 60 beats/minute. Pre-, intra-, and postoperative heart rate (HR) and blood pressure were reviewed retrospectively in 125 patients who underwent surgery for tumors of the cerebellopontine angle (CPA), and they were divided into a TCR group and a non-TCR group. Of the 125 patients, 14 (11%) showed evidence of TCR during dissection of the tumor near the trigeminal nerve at the brainstem. Their HR fell 38% and their MABP fell 48% during operative procedures as compared with preoperative levels. After cessation of manipulation, the HR and the MABP returned to preoperative levels. Risk factors for the occurrence of TCR were compared with results from the literature. The authors' results show the possibility of occurrence of a TCR during manipulation of the central part of the trigeminal nerve when performing surgery in the CPA.

Trigeminocardiac reflex: differential behavior and risk factors in the course of the trigeminal nerve

2014 ◽  
Vol 9 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Tumul Chowdhury ◽  
Nora Sandu ◽  
Cyrill Meuwly ◽  
Ronald B Cappellani ◽  
Bernhard Schaller
Keyword(s):  
Risk Factors ◽  
Trigeminal Nerve ◽  
Trigeminocardiac Reflex ◽  
Differential Behavior

scholarly journals A near catastrophe from trigeminocardiac reflex

2017 ◽  
Vol 04 (02) ◽  
pp. 124-126
Author(s):  
Parmod Bithal ◽  
Ravees Jan ◽  
Khalid Qadah ◽  
Ghadah Al Kahtani
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Female Patient ◽  
Gastric Motility ◽  
Signs And Symptoms ◽  
Trigeminocardiac Reflex ◽  
Brainstem Reflex ◽  
The Face ◽  
Refractory Hypotension ◽  
Stimulation Of

AbstractTrigeminocardiac reflex is a brainstem reflex that results from stimulation of any branch of the trigeminal nerve along its course. It produces a constellation of signs and symptoms decrease in blood pressure (BP) and heart rate, dysrhythmias, apnoea and increased gastric motility. We present a case of 80-year-old female patient who developed alarming hypotension and bradycardia during craniotomy for meningioma excision resulting from this reflex. In the face of refractory hypotension despite administering ephedrine and phenylephrine, we had to resort to adrenaline to restore her normal BP.

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