Regarding Trigeminocardiac Reflex in Paediatric Adenotonsillectomy: A Report of Two Cases With Literature Review

Abstract

We came across this very interesting and thoughtprovoking article, titled "Trigeminocardiac Reflex in Paediatric Adenotonsillectomy: A Report of Two Cases With Literature Review," by Li et al. 1 in your esteemed journal. It is well written, and we appreciate the authors' on their remarkable efforts for having explored this area of trigeminocardiac reflex (TCR), which still remains an area that demands more research.We would like to bring in few more points on TCR, which we hope will be of added value to this well-written article. In the article "Trigeminocardiac Reflex: New Thinking Model About the Definition Based on a Literature Review," 2 it has been stated that it is important to have a repetition of the reflex with the same end result each time before concluding that it is due to TCR. In your study, we find that a repetition of the stimulus has not been done before concluding that it is a TCR. Also, various authors have stated in their studies that TCR may behave differently in the pediatric population when compared with that of adults. We would like to suggest the use of intraoperative nerve monitoring to detect the stimulation of trigeminal nerve and thereby prove TCR.We would also like to stress the need to study a larger pediatric population to state definitely this significant problem.