Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Profound trigeminocardiac reflex from lingual nerve stimulation: a case report

  • Champion, Allen (Oral and Maxillofacial Surgery, Thomas Jefferson University) ;
  • Masi, John (Oral and Maxillofacial Surgery, Thomas Jefferson University)
  • Received : 2021.12.06
  • Accepted : 2022.01.04
  • Published : 2022.02.01
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Abstract

Trigeminocardiac reflex (TCR) is a well-known brainstem reflex that manifests as hypotension, bradycardia, dysrhythmia, and asystole when stimulation is applied to a branch of the trigeminal nerve. Most commonly associated with ophthalmic, orbital, and neurologic surgeries, mandibular division and oral cavity variants occur far less frequently. Here, we describe a case of asystolic TCR elicited by lingual nerve stimulation. This case highlights the role of specific anesthetic medications in modulating this phenomenon and reinforces the need for early recognition and clear communication in case of its occurrence. Anesthesia providers must consider discontinuing or avoiding certain medications when clinically appropriate, even during low TCR-risk procedures.

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References

  1. Shelly MP, Church JJ. Bradycardia and facial surgery (letter). Anesthesia 1988; 43: 422. https://doi.org/10.1111/j.1365-2044.1988.tb09042.x
  2. Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 1999; 90: 215-20. https://doi.org/10.3171/jns.1999.90.2.0215
  3. Lubbers HT, Zweifel D, Gratz KW, Kruse A. Classification of potential risk factors for trigemioncardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg 2010; 68: 1317-21. https://doi.org/10.1016/j.joms.2009.12.039
  4. Lang S, Lanigan DT, van der Wal M. Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. Can J Anaesth 1991; 38: 757-60. https://doi.org/10.1007/BF03008454
  5. Arasho B, Sandu N, Spiriev T, Prabhakar H, Schaller B. Management of the trigeminocardiac reflex: facts and own experience. Neurol India 2009; 57: 375-80. https://doi.org/10.4103/0028-3886.55577
  6. Arnold RW, Jensen PA, Kovtoun TA, Maurer SA, Schultz JA. The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q 2004; 19: 215-22.
  7. Scheiermann P, Herzog F, Siebenhofer A, Strametz R, Weberschock T. Intravenous versus inhalational anesthesia for pediatric inpatient surgery - a systematic review and meta-analysis. J Clin Anesth 2018; 49: 19-25. https://doi.org/10.1016/j.jclinane.2018.05.014
  8. Choi SR, Park SW, Lee JH, Lee SC, and Chung CJ. Effect of different anesthetic agents on oculocardiac reflex in pediatric strabismus surgery. J Anesth 2009; 23: 489-93. https://doi.org/10.1007/s00540-009-0801-0
  9. Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand 2008; 52: 1273-7. https://doi.org/10.1111/j.1399-6576.2008.01745.x
  10. Choi SH, Lee SJ, Kim SH, Kim JH, Kwon HH, Shin YS, et al. Single bolus of intravenous ketamine for anesthetic induction decreases oculocardiac reflex in children undergoing strabismus surgery. Acta Anaesthesiol Scand 2007; 51: 759-62. https://doi.org/10.1111/j.1399-6576.2007.01329.x
  11. Hahnenkamp K, Honemann CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr Anaesth 2000; 10: 601-8. https://doi.org/10.1046/j.1460-9592.2000.00588.x
  12. Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran 2015; 53: 158-61.
  13. Mizrak A, Erbagci I, Arici T, Ozcan I, Ganidagli S, Tatar G, et al. Ketamine versus propofol for strabismus surgery in children. Clin Ophthalmol 2010; 19: 673-9.
  14. Oh JN, Lee SY, Lee JH, Choi SR, Chin YJ. Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean J Anesthesiol 2013; 64: 500-4. https://doi.org/10.4097/kjae.2013.64.6.500