Determination of trigeminocardiac reflex during rhinoplasty

Yorgancılar, Ediz; Gün, Ramazan; Yıldırım, Mehmet; Bakır, Salih; Akkuş, Zeki; Topçu, İsmail

doi:10.1016/j.ijom.2011.12.025

Cited by 29 publications

(19 citation statements)

References 19 publications

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“…through a prospective study in the patients who underwent rhinoplasty procedures reported an 8.3% incidence of TCR. [28] Regrettably, they did not evaluate the depth of anesthesia and additionally, they defined a TCR episode as a sudden decrease of more than 10% in only one hemodynamic item (HR) of the patients (without considering decrease in blood pressure). This may be a reason for overestimating the incidence of TCR in their study.…”

Section: Discussionmentioning

confidence: 99%

“…It is noteworthy to mention that irrespective of two prospective studies in the literature, all of investigations regarding TCR had been performed either as a retrospective study or as case reports. [61113151620212428] Considering wide variations regarding the incidence of this phenomenon during cranial neurosurgical procedures, and paucity of reliable data, we intended to design a prospective observational study to determine the true incidence of TCR in patients who were anesthetized with a standard technique for supra- and infra-tentorial cranial and skull base procedures.…”

Section: Introductionmentioning

confidence: 99%

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Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Etezadi

Orandi²,

Orandi³

et al. 2013

Surg Neurol Int

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Background:Considering wide variations regarding the incidence of trigeminocardiac reflex (TCR) during cranial neurosurgical procedures, and paucity of reliable data, we intended to design a prospective study to determine the incidence of TCR in patients undergoing standard general anesthesia for surgery of supra/infra-tentorial cranial and skull base lesions.Methods:A total of 190 consecutive patients candidate for elective surgery of supra-tentorial, infra-tentorial, and skull base lesions were enrolled. All the patients were operated in the neurosurgical operating room of a university-affiliated teaching hospital. All surgeries were performed using sufficient depth of anesthesia achieved by titration of propofol–alfentanil mixture, adjusted according to target Cerebral State Index (CSI) values (40-60). All episodes of bradycardia and hypotension indicating the occurrence of TCR during the surgery (sudden decrease of more than 20% from the previous level) were recorded.Results:Four patients, two female and two male, developed episodes of TCR during surgery (4/190; 2.1%). Three patients showed one episode of TCR just at the end of operation when the skin sutures were applied while CSI values were 70-77 and in the last case, when small tumor samples were taken from just beneath the lateral wall of the cavernous sinus TCR episode was seen while the CSI value was 51.Conclusion:TCR is a rare phenomenon during brain surgeries when patient is anesthetized using standard techniques. Keeping the adequate depth of anesthesia using CSI monitoring method may be an advisable strategy during whole period of a neurosurgical procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Etezadi

Orandi²,

Orandi³

et al. 2013

Surg Neurol Int

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“…[5131618212530] There are varieties of case reports in neurosurgical literature regarding the occurrence of TCR; during surgery within cerebellopontine angle (CPA),[25] around the brain stem[16] and the territory of the trigeminal nerve,[3] during transsphenoidal pituitary surgery,[4] while removing a falcine meningioma,[2] during draining of a subdural empyema,[26] when working around the eye and face especially in children,[5] during fixation of the stereotaxic frame,[27] with LeFort I osteotomy,[12] during embolization of intradural, dural or extradural highly vascular pathologies,[1314] while elevating the skin for craniotomy[17] or closing the skin at the end of the procedure,[6] and when connecting negative pressure to the subgaleal drain. [10]…”

Section: Discussionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

Amirjamshidi

Etezadi²,

Ghasemi³

2013

Surg Neurol Int

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Background:Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve are coined as trigeminocardiac reflex (TCR). Neither enough is known about the predisposing factors in relation with the intraoperative occurrence of this life threatening reflex, nor about the exact pathophysiology of its brain stem pathway.Encountering two cases of bradycardia and hypotension during surgery encouraged the authors to: (1) report these two cases and review similar reports in the relevant literature, (2) discuss the suggested mechanisms for such an event, and (3) report the result of a prospective cohort of precisely checked cases in a sister article, to remind the younger neurosurgical community of a possible and bothering even mortal, but avoidable complication in their everyday practice.Case Description:The first case was a 71-year-old male who developed bradycardia and hypotension while packing his large sella tursica with autologous fat after removing a large nonfunctional pituitary adenoma transsphenoidally to prevent cerebrospinal fluid leakage. The changes in his vital signs were detected and controlled rapidly.The second case was a 52-year-old female who underwent right pterional craniotomy for right clinoidal meningioma. She developed severe bradycardia and hypotension after skin closure completed and just when the subgaleal drain was connected to the aspirating bag and negative pressure maintained in the subgaleal region.Both cases could be managed successfully after on time detection of such life threatening complication and proper management.Conclusion:We do not intend only to add two new cases of TCR occurring in the perioperative period in neurosurgical practice, but we wish to raise the question: (a) what could be the predisposing factors for development of such issue for better handling of the problem and (b) stress upon careful continuous mapping of the vital signs during surgery and even till very late after operation.

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“…Other studies are being carried out to find out its occurrence in other neurosurgical procedures and the corresponding outcomes. Furthermore, TCR episodes have been reported in non-neurosurgical procedures including maxillofacial surgeries, nasal surgeries, nasal endoscopic procedures, dental extractions and injections, and even during local infiltration [3,[17][18][19]. Similarly, strength of stimulus, which is considered as most important inciting factor is also challenged in some recent papers [1][2][3].…”

mentioning

confidence: 99%

Trigeminocardiac reflex: current trends

Chowdhury

Sandu

Sadr-Eshkevari³

et al. 2013

Expert Review of Cardiovascular Therapy

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Since the first introduction of the trigeminocardiac reflex (TCR) in 1999, substantial new knowledge about this brainstem reflex has been created. First, by different clinical case reports and case studies, and second, from basic research that gives inputs from bench to bedside. In the present work, the authors therefore introduce the molecular/anatomical knowledge of the TCR and show its different connections to clinical aspects. Special reference is given to prevention and treatment of the TCR; but always with a link to knowledge of the basis sciences. In such a context different topics of future interest are introduced.

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Determination of trigeminocardiac reflex during rhinoplasty

Cited by 29 publications

References 19 publications

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

Trigeminocardiac reflex: current trends

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