Incidence Of Trigeminocardiac Reflex Research Articles

Risk factors associated with trigeminocardiac reflex in patients with trigeminal neuralgia during percutaneous balloon compression: A retrospective cohort study

BackgroundThe trigeminocardiac reflex (TCR) is a brainstem reflex commonly elicited during percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN), which is characterized by drastic hemodynamic disturbances, such as bradycardia, arrhythmias and even cardiac arrest. In order to prevent catastrophic consequences, it is vital to screen the risk factors of TCR during perioperative period. The primary purpose of this study was to identify potential risk factors associated with TCR in patients with TN undergoing PBC, and to summarize the enlightenment of clinical anesthesia management. MethodsThe clinical data of 165 patients diagnosed with TN undergoing PBC from January 2021 to December 2021 were retrospectively analyzed. TCR was defined as a sudden decrease in heart rate of 20% or more compared with baseline, and / or cardiac arrest, coinciding with the stimulus of any branch of the trigeminal nerve. And a clear cause-effect relationship between heart rate reduction and PBC-related intervention was required. All demographic characteristics as well as surgical and anesthetic data were compared between TCR group and TCR-free group. Univariate and multivariate logistic regression analysis were used to further analyze TCR-related risk factors. ResultsOf the 165 patients enrolled in this study, 73 (44.2%) were male and 92 (55.8%) were female, and the average age was 64.22 ± 9.72 years. The incidence of TCR in the patients with TN during PBC was 54.5%. The results of multivariate regression analysis indicated that the risk factor for TCR was heart rate < 60 beats/min immediately before foramen ovale puncture (OR: 4.622; 95%CI: 1.470–14.531; P < 0.05). ConclusionHeart rate < 60 beats/min immediately before foramen ovale puncture was independently associated with TCR. Therefore, it is necessary for anesthesiologists to raise heart rate appropriately to prevent TCR during PBC.

The Effect of Atropine on Trigeminocardiac Reflex-induced Hemodynamic Changes During Therapeutic Compression of the Trigeminal Ganglion.

Percutaneous compression of the trigeminal ganglion (PCTG) can induce significant hemodynamic perturbations secondary to the trigeminocardiac reflex (TCR). The aim of this study was to investigate the effect of atropine pretreatment on hemodynamic responses during PCTG for trigeminal neuralgia. A total of 120 patients who received PCTG were randomly assigned to control and atropine groups that were pretreated with saline (n=60) and atropine 0.004 mg/kg intravenously (n=60), respectively. Heart rate (HR) and mean arterial pressure (MAP) were measured at 9 timepoints from before induction of anesthesia until the end of the PCTG procedure; the incidence of TCR was also observed. HR was higher in the atropine compared with control group from the time of skin puncture with the PCTG needle until after the procedure was completed (P<0.05). MAP was also higher in the atropine compared with control group, but only at entry of the needle into the foramen ovale until 1 minute after trigeminal ganglion compression (P<0.05). HR was reduced in both groups during entry of the needle into the foramen ovale and during ganglion compression, but less so in the atropine compared with the control group (P<0.05). MAP increased during PCTG compared with baseline in both groups, but with a larger increase in the atropine group (P<0.05). Two and 52 cases in the control group, and 6 and 1 cases in the atropine group, exhibited a TCR during entry of the needle into the foramen ovale and at ganglion compression, respectively (P<0.05). Pretreatment with atropine was effective in most patients at minimizing abrupt reduction in HR during PCTG.

Trigeminocardiac reflex and anesthesia

Trigeminocardiac reflex (TCR) is a well-established brain stem reflex that manifests as sudden cardiac perturbations, including bradycardia, arterial hypotension, asystole, apnea, and gastric hypermobility by surgical stimulation. The intense episode of the TCR is life-threatening. It has been widely concerned by anesthesiologists because of the great amount of surgeries could be involved in TCR and the high incidence of TCR. This review summarized the definition, pathological mechanisms, classification, incidences and its correlation with anesthesia, prevention, treatment and prognosis of the TCR so as to provide a reference for anesthesiologists to recognize and manage the TCR in time during general anesthesia. Key words: Trigeminocardiac reflex; Anesthesia

The Effect of Depth of Anesthesia on Hemodynamic Changes Induced by Therapeutic Compression of the Trigeminal Ganglion.

Percutaneous compression of the trigeminal ganglion (PCTG) has been used to treat trigeminal neuralgia since 1983. A PCTG-related trigeminocardiac reflex (TCR) can induce dramatic hemodynamic disturbances. This study investigates the effects of depth of propofol anesthesia on hemodynamic changes during PCTG. A total of 120 patients who underwent PTCG for trigeminal neuralgia were randomly assigned to control group-intravenous saline pretreatment before PCTG puncture and anesthesia targeted to bispectral index (BIS) 40 to 60 throughout, and study group-intravenous propofol 1 to 2 mg/kg pretreatment to deepen anesthesia to BIS<40 before PCTG. Mean arterial pressure, heart rate (HR), cardiac output, system vascular resistance, and BIS were measured at 9 time points during the procedure, and the incidence of the TCR was observed at T5 and T6. BIS was lower in the study group compared with the control after pretreatment with propofol or saline, respectively. Compared with the control group, mean arterial pressure was lower in the study group at several points during the procedure, but there was no difference in HR between the 2 groups at any point. Cardiac output was higher and system vascular resistance lower in the study compared with the control group. In the control group, 42 (70.0%) and 52 (86.7%) of patients developed a TCR at the 2 points, and 37 (67.1%) and 45 (75.0%) in the study group. There was no difference in the incidence of TCR between the 2 groups. Increasing the depth of propofol anesthesia partially attenuated PTCG-related elevation of blood pressure but did not modify the abrupt reduction in HR.

Incidence of trigeminocardiac reflex in maxillofacial surgery: A retrospective study

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex that has attracted the attention of many clinical researchers, including neurosurgeons, anaesthetists, ophthalmologists, and general, plastic, and craniomaxillofacial surgeons. However, more maxillofacial surgery studies related to TCR need to be conducted in order to better understand this phenomenon. Aim: The aim of this study was to evaluate the occurrence of TCR during maxillofacial procedures performed between 2008 and 2012 including trauma, orthognathic, and reconstructive surgeries. Additionally, with a literature review provide information regarding its incidence, predisposing factors and management. Subjects and Methods: A five-year retrospective study was conducted to evaluate the charts of 56 healthy patients (classified as American Society of Anaesthesiologists class I) admitted in the Department of Oral and Maxillofacial Surgery from 2008 through 2012 at King Abdulaziz Medical City (formerly known as King Khalid National Guard Hospital), Jeddah. Information regarding the different types of procedures and occurrence of TCR in each case was collected. SPSS (V 11.5) was used to analyse the data collected. Results: The overall incidence of TCR was 20% of all the cases, with the highest percentage occurring during mid face trauma repair followed by upper face reconstructive surgeries. Conclusions: TCR can be fatal and must be taken in consideration. All craniomaxillofacial surgeons are advised to follow guidelines for the management of TCR illustrated by Arasho et al . in 2009.

Trigeminocardiac Reflex after Direct Infusion of Chemotherapy into the Ophthalmic Artery for Retinoblastoma

Introduction: Direct intra-ophthalmic artery infusion of chemotherapy has emerged as a front-line treatment modality for both early and advanced forms of retinoblastoma. The procedure has become common practice for neurointerventionalists at institutions with major ophthalmology centers. We present a case series of patients who manifest an autonomic reaction of acute hypoxemia, hypocapnia, hypotension, and bronchospasm consistent with trigeminocardiac reflex. We report our experience with this reaction, which is commonly seen during pediatric strabismus surgery but until now, rarely seen in the neuroangiography suite. Methods: We retrospectively reviewed our 5-year experience with intra-ophthalmic artery chemotherapy infusion for retinoblastoma. Procedure notes, anesthetic records, patient characteristics, and chemotherapeutic agents used were reviewed. Results: Over a 5-year period, 199 treatment sessions were performed in 49 patients. Twenty-eight TCR events were observed in 18 patients. Twenty-seven of these were quickly terminated following interruption of chemotherapy infusion, ventilatory support, and administration of pressor agents. In one case the procedure was aborted due to the prolonged duration of the reflex. There were no permanent sequelae. Conclusions: We found an appreciable incidence of trigeminocardiac reflex to intra-ophthalmic artery infusion of chemotherapy in patients with retinoblastoma. Both interventionalists and anesthesiologists should be aware of this potential event and be prepared to provide immediate resuscitative measures.

English

Introduction Ankylosis is a serious and handicapping problem and has been associated with a lot of hazards from chewing problems and malnutrition up to frank sleep apnoea syndrome (OSA) and life threatening upper air way complications during anaesthesia. On the other hand, trigeminocardiac reflex (TCR) consists of dysrhythmias, hypotension, apnoea and gastric hypermotility. Clinically, it is encountered in cranio-maxillo facial and occular surgeries. In this study we try to study the incidence of TCR due to forcible mouth opening by bi-block prosthesis following TMJ procedures after regional nerve blocks of maxillary and mandibular nerves. Materials and methods 100 patients enrolled for TMJ surgeries are grouped into 2 groups each containing 50 patients, control group (C-group) and nerve block group (NB-group) in which maxillary and mandibular nerves are blocked. Acrylic – bi-block prosthesis is inserted. The incidence of TCR (which is defined by a drop in both HR and MABP in > 20% of the base line values), also lowest H.R, occurrence of asystole, dysrhythmias and lanyngospasm, all are reported intraoperatively. Results There is a significant drop of incidence of TCR in the NB group (0%) compared to the C-group (2/50 – 4%). The lowest H.R. is insignificantly higher in the NB-group (49+3) Than the C-group (44+2). There was no haemodynamically significant hypotension, arrhythmias or laryngospasm. Conclusion Prophylactic nerve blockade at end of TMJ procedures and before bi-block prosthesis application is efficient to reduce the incidence of TCR.

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

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.