A profound case of neurally mediated syncope with asystole after septoplasty

Ruhl, Douglas S.; Ramsey, Mitchell J.; Ruffin, David M.

doi:10.1016/j.jclinane.2011.10.006

Cited by 1 publication

(1 citation statement)

References 31 publications

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“…Further reported cases observed asystole during less similar settings, such as during surgery with major manipulation of the nasal skin and deeper structures, for example, dissection of the right frontal recess,17 after surgery possibly caused by nasal packing18 or ventricular fibrillation caused by local administration of minimal doses of epinephrine in the nasal mucosa 19. Different to those cases, we observed a manifestation of TCR as asystole during minimal manipulation in a surgery setting and there they are not comparable.…”

Section: Discussioncontrasting

confidence: 79%

Sinus arrest with prolonged asystole due to the trigeminocardiac reflex during application of local anaesthetic in the nasal mucosa

Meuwly¹,

Leibundgut

Rosemann

et al. 2018

BMJ Case Reports

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The trigeminocardiac reflex (TCR) is defined as a sudden onset of parasympathetic dysrhythmias during stimulation of the trigeminal nerve. We describe a peripheral variation of TCR during manipulation of the nasal mucosa. A 42-year-old patient suffering from severe obstructive sleep apnoea was scheduled for surgical treatment. After inducted anaesthesia, the surgeon infiltrated the nasal mucosa with a local anaesthetic. The patient immediately showed an asystole and was treated with ephedrine and five chest compressions, despite spontaneous sinus rhythm return after ceasing of manipulation. Treatment with atropine established this TCR episode and ensured an event-free surgery.The authors present here, for the first time, a prolonged asystole caused by the TCR, triggered by minimal manipulation of the nasal mucosa. This severe manifestation of peripheral TCR demonstrates its importance in daily clinical business. This case was treated according to a modified treatment algorithm for all subtypes of TCR which is presented here.

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Section: Discussioncontrasting

confidence: 79%