Anesthetic Influence on Occurrence and Treatment of the Trigemino-Cardiac Reflex
نویسندگان
چکیده
Trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmia including hypotension, apnea, and gastric hypermotility during stimulation of any branches of the trigeminal nerve. Previous publications imply a relation between TCR and depth of anesthesia. To gain more detailed insights into this hypothesis, we performed a systematic literature review.Literature about occurrence of TCR was systematically identified through searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (MEDLINE), EMBASE (Ovid SP), and the Institute for Scientific Information (ISI Web of Sciences) databases until June 2013, as well as reference lists of articles for risk calculation. In this study, TCR was defined as drop in mean arterial blood pressure and heart rate, both >20% to baseline. We calculated intraoperative cerebral state index (CSI) of each TCR-case using a newly developed method. These data were further divided into 3 subgroups: CSI <40 (deep anesthesia), CSI 40-60 (regular anesthesia), and CSI >60 (slight anesthesia).Including 45 studies with 910 patients, 140 (15%) presented with TCR, and 770 (85%) without TCR during operation. TCR occurrence showed a 1.2-fold higher pooled risk slighter anesthesia (CSI <40: 13%, at CSI 40-60: 21%, and at CSI >60: 27%) compared with deeper anesthesia. In addition, we could discover a 1.3-fold higher pooled risk of higher MABP drop with a strong negative correlation (r = -0.935; r = 0.89) and a 4.5-fold higher pooled risk of asystole during TCR under slight anesthesia compared with deeper anesthesia.Our work is the first systematic review about TCR and demonstrates clear evidence for TCR occurrence and a more severe course of the TCR in slight anesthesia underlying the importance of skills in anesthesia management during skull base surgery. Furthermore, we have introduced a new standard method to calculate the depth of anesthesia.
منابع مشابه
Trigemino-cardiac reflex during chronic subdural haematoma removal: report of chemical initiation of dural sensitization
The trigemino-cardiac reflex is a well-known clinical phenomenon described during different craniofacial or skull base surgery as well as neuroradiological interventions and defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during (intraoperative) stimulation of any of the sensory branches of the trigeminal nerve. According to ...
متن کاملA new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report
INTRODUCTION The trigemino-cardiac reflex 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, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological ...
متن کاملCardiac autonomic control in neurosurgery the example of trigemino-cardiac reflex
The trigemino-cardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnoea or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. In the present review, we summarize the knowledge about the TCR in relation to its two different ways of stimulation: (i) peripheral and (ii) central stimulation. We a...
متن کاملرفلکس تریژمینوکاردیاک در جراحی اعصاب کف جمجمه: گزارش موردی
Background: The Trigemino-cardiac reflex (TCR) has been studied as a phenomenon including bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a...
متن کاملThe Role of Acute Trigemino-Cardiac Reflex in Unusual, Non-Surgical Cases: A Review
Trigemino-cardiac reflex (TCR) is a well-established phenomenon that is mainly reported in the various surgical specialties. However, the role of this unique reflex is entirely unknown in other medicine domains. Therefore, the present mini-review aims to explore the role of TCR in such unusual cases and also highlights the importance of case reports for knowledge creation in such context.
متن کامل