Abstract
The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR in 1999, there is an ongoing discussion about a more emergent clinical definition. In this work, the author worked out an approach to such an improved definition. In this study, a grounded theory approach was used. Literature about TCR was systematically identified through PubMed (MEDLINE), EMBASE (Ovid SP), and ISI Web of Sciences databases from 1/2005 until 8/2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. A grounded theory approach was used to analyze and interpret the data through a synthesis by the researcher's perspectives, values, and positions. Out of the included studies, the authors formed available data to an update of the understanding of changes in hemodynamic parameters (HR and blood pressure) in a TCR. According to this update, an HR deceleration should be a constant observation to identify a TCR episode while a drop in blood pressure should probably not being fixed to a certain percentage of decrease. The here presented working definition improves our understanding of the TCR. It leads the way to a new understanding of the TCR for a proper clinical definition.
Highlights
The trigeminocardiac reflex (TCR) is a phylogenetic old reflex that manifests as sudden onset of changes in hemodynamic parameters, such as heart rate (HR) and mean arterial blood pressure (MABP), and apnea and gastric hypermotility during stimulation of any branches of the trigeminal nerve
The generally best-known oculocardiac reflex is included as a peripheral subtype of the TCR
In regard to the afferent pathway, there exist marked differences in subtypes of TCR, which lead to different reflex arcs
Summary
The trigeminocardiac reflex (TCR) is a phylogenetic old reflex that manifests as sudden onset of changes in hemodynamic parameters, such as heart rate (HR) and mean arterial blood pressure (MABP), and apnea and gastric hypermotility during stimulation of any branches of the trigeminal nerve. Schaller and colleagues examined the TCR in various clinical variants during the following years [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23] and developed the nowadays-established classification between the peripheral, central, and ganglion subtype of TCR [24] In this structured classification, the generally best-known oculocardiac reflex is included as a peripheral subtype of the TCR. The author worked out an approach to such an improved definition
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