Trigemino-cardiac reflex may be refractory to conventional management in adults

Abstract

Dear Sir, We appreciate the interest of Schaller and colleagues in our articles on trigemino-cardiac reflex (TCR) [2, 3]. Trigeminocardiac reflex was found to be refractory to the conventional methods of treatment and use of vasopressor was required as reported [2]. We are in line with works of Schaller and colleagues and believe that the reflex could be more of a physiological entity. It could possibly be considered a ‘protective reflex’ during the skull-base surgery as its occurrence suggests manipulation of the vital structures in the brain. It has been reported that cardiovascular changes like bradycardia and sinus arrest can occur following exposure of brain to high temperature [5]. Therefore, heat produced by bipolar coagulation and triggering TCR could also be considered a possibility, as suggested by Schaller and colleagues. It would, however, be interesting to note the clinical outcome of patients who elicit the reflex during intraoperative period. The recent work of Schaller and colleagues [4] and Gharabaghi and colleagues [1] is appreciable and could help provide an answer although there is still a long way to reach the goal.