Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby

Abstract

The trigeminocardiac reflex (TCR) is an established brainstem reflex leading to parasympathetic dysrhythmias—including haemodynamic irregularities, apnoea and gastric hypermotility—during stimulation of any sensory branches of the trigeminal nerve. Most of the clinical knowledge about TCR was gathered from general anaesthesia observations, not from procedural sedation.We present a case of a 6-month-old premature baby experiencing the reflex twice under dexmedetomidine–propofol-sedation while undergoing ophthalmic and ear examination. This was interpreted as cross-over sensitisation between the facial and trigeminal cranial nerve (N V and N VII).The present case demonstrates that different TCR subtypes can occur during the same anaesthetic procedure. Triggering TCR seems to be based on several factors and not just on a single stimulus as often presumed. Therefore, for premature babies, there is a risk for TCR under procedural sedation, and we recommend using glycopyrrolate as preventive treatment.