Coronary Artery Spasm Induced by Trigeminal Nerve Stimulation and Vagal Reflex During Intracranial Operation

Kariya, Nobutaka; Toyoyama, Hirokatsu; Furuichi, Katsuji; Kubota, Hiroshi; Toyoda, Yoshiro

doi:10.1097/00008506-199907000-00009

Cited by 13 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 Some of these efferent fibers terminate in the myocardium and act as cardioinhibitors, leading to hypotension, bradycardia, asystole, and ventricular fibrillations through coronary vasospasm. 17 Other efferent fibers induce apnea or gastric hypermotility. 9 Removing the triggering factor can cause cessation of the reflex, raising hemodynamic parameters to normal levels.…”

Section: Discussionmentioning

confidence: 99%

The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

Gharabaghi

Koerbel

Samii

et al. 2006

JNS

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

Gharabaghi

Koerbel

Samii

et al. 2006

JNS

View full text Add to dashboard Cite

show abstract

“…Regional anesthesia, vasopressors, hyperventilation, hypotension, and inadequate depth of anesthesia were noted as major contributing factors. Sidi et al [1] also reviewed CAS in detail and found results very similar to those of Chang et al In addition to the traditional contributing factors already mentioned, oculocardiac reflex [3], anaphylaxis [4,5], carotid sinus stimulation [6], neurological procedures [7][8][9], rocuronium [10], dolasetron [11], prostaglandin E 1 , and beta-adrenergic blockade [12] are also recently reported factors.…”

Section: Discussionmentioning

confidence: 53%

“…A number of existing reports address use of vasopressors for the treatment of unstable hemodynamics resulting from CAS [1,2,4,5,9,[15][16][17][18][19][20]. We thought it necessary to maintain coronary perfusion pressure with vasopressors to counteract the reduced coronary circulation caused by CAS.…”

Section: Discussionmentioning

confidence: 99%

A case of intraoperative coronary artery spasm in a patient with vascular disease

et al. 2010

View full text Add to dashboard Cite

A 66-year-old man with a history of longtime smoking, untreated hypertension, hyperlipidemia, and impaired glucose tolerance but no history of myocardial infarction or angina pectoris was scheduled for right aortofemoral bypass and thromboembolectomy for arteriosclerosis obliterans with right common iliac and right popliteal arterial thrombus. Epidural anesthesia and general anesthesia were administered without obvious ECG changes. Just after skin incision, ST elevation in leads II and V5 and a short run of ventricular tachycardia with frequent premature ventricular contractions (PVCs) were recorded on the ECG monitor, and the patient's blood pressure suddenly decreased within a few seconds. On noticing these changes, we suspected coronary artery spasm (CAS) and rapidly administered vasodilators and vasopressors to stabilize hemodynamics and ECG changes. Transesophageal echocardiography (TEE) showed basal to mid- and anteroseptal to inferior wall motion hypokinesis that gradually returned to normal during observation. Even in patients without coronary disease but with systemic arteriosclerosis, it is important to consider the possibility of perioperative CAS and not to overlook ECG changes. Immediate diagnosis and treatment are essential.

show abstract

“…Vagal mediated reflex was also thought to attribute to some cases which presented with changes in heart rate, hypotension, ST-elevation, and even ventricular fibrillation during drilling for burr hole [8, 9]. In this case (52 y, male) when burr holes were made for the craniotomy, patient developed bradycardia without changes of MAP suddenly and the ECG in lead II showed sudden elevation of the ST-segment (0.3 mV).…”

Section: Exemplary Casesmentioning

confidence: 94%

Coronary Spasm in Neurosurgical Patients and Role of Trigeminocardiac Reflex

Chowdhury

Meuwly

Sandu

et al. 2014

Neurology Research International

View full text Add to dashboard Cite

Background. Coronary artery spasm (CAS) is a rarely reported complication in neurosurgical patients and its main causative mechanism was attributed to vagal mediated responses. However, these may be the unusual manifestations of trigeminal cardiac reflex (TCR) which is a well established brain stem reflex observed in various neurosurgical patients. Methods and Results. In this review, we have searched for the case reports/papers related to intraoperative coronary spasm in neurosurgical patients and described the role of TCR in this regard. TCR is a possible mechanism in producing CAS in most of the cases in which stimulation occurred at or near the vicinity of trigeminal nerve. It is likely that TCR mediated coronary spasm may be a physiological mechanism and not related to actual myocardial insult apparent by cardiac enzymes or echocardiography studies in most of the cases. Some common risk factors may also exist related to occurrence of CAS as well as TCR. Conclusions. In conclusion, neurosurgical procedures occurring at the vicinity of trigeminal nerve may produce CAS even in previously healthy patients and may produce catastrophic consequences. There is a need for future reports and experimental studies on the interaction of TCR and pathophysiological mechanisms related to CAS.

show abstract

Coronary Artery Spasm Induced by Trigeminal Nerve Stimulation and Vagal Reflex During Intracranial Operation

Cited by 13 publications

References 0 publications

The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

A case of intraoperative coronary artery spasm in a patient with vascular disease

Coronary Spasm in Neurosurgical Patients and Role of Trigeminocardiac Reflex

Contact Info

Product

Resources

About