Asystole during posterior fossa surgery: Report of two cases

Abstract

Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have been implicated, especially when surgical manipulation is carried out in the vicinity of the brain stem. The trigemino-cardiac reflex has been attributed as one of the causes. Here, we report two cases who suffered asystole during the resection of posterior fossa tumors. The vago-glossopharyngeal reflex and the direct stimulation of the brainstem were hypothesized as the causes of asytole. These episodes resolved spontaneously following withdrawal of the surgical stimulus emphasizing the importance of anticipation and vigilance during critical moments of tumor dissection during posterior fossa surgery.

Anesthesia Management in Massive Occipital Meningoencephalocele with Chiari III Malformation: A Case Report

“…The intraoperative risk of hemodynamic instability and bradycardia is high in patients with CM owing to manipulation of the brainstem. 3 In patients with a large occipital meningoencephalocele, positioning for intubation and surgery is an issue. 4 Previously Ganeriwal et al 5 reported the use girdle cushion platform made of gauze to position the patient's lesion (12.1 x 11.7 × 8.4 cm) for airway manipulation.…”

Neurogenic Bradycardia in Perioperative of Neurosurgery: A Dreadful Complication 2 Cases and Literature Review

“…These reactions can also be caused by activation of the trigeminal cardiacreflex (TCR) due to direct stimulation of the trigeminal nerve or its branches in the duramater or the cerebellar tentorium [3]. The trigeminal nerve and the cardioinhibitory vagus nerve constitute the afferent and efferent pathways of the reflex arc.…”

Emergencias cardiacas en pacientes neuroquirúrgicos

“…La bradicardia neurogénica puede ser provocada por la activación del RGV debido a la estimulación directa del nervio glosofaríngeo cerca del área operatoria. Los impulsos del noveno par viajan a través del tracto solitario del mesencéfalo comunicándose con el núcleo solitario, desde donde la neurotransmisión excitadora al núcleo dorsal (motor) del vago aumenta la actividad parasimpática en el corazón, ocasionando bradicardia refleja y a veces asistolia, además envía señales inhibidoras a las astas intermediolaterales en la médula espinal a través de la médula ventrolateral rostral, disminuyendo el flujo simpático hacia los vasos sanguíneos manifestándose como hipotensión post-vasodilatación 42,43 . Del mismo modo, la estimulación directa del nervio vago puede provocar trastornos hemodinámicos graves como bradicardia, bloqueo de rama y asistolia 1,42,44 .…”