Severe Trigeminocardiac Reflex During Neurosurgery- What Should We Do
Muhammad Luthfi (a), Budiana Rismawan(b), Iwan Fuadi (b), Erwin Pradian (b), Suwarman (b), Reza W. Sudjud (b)

(a) Resident of Anesthesiology and Intensive Care Department , Faculty of Medicine Universitas Padjadjaran Hasan Sadikin Hospital Bandung Bandung West Java
(b) Consultant of Anesthesiology and Intensive Care Department , Faculty of Medicine Universitas Padjadjaran Hasan Sadikin Hospital Bandung Bandung West Java

Abstract

Introduction : Trigeminocardiac reflex (TCR) is one of the brainstem reflexes that can cause sudden onset of parasympathetic activity, sympathetic hypotension, apnea, and gastric hypermotility during central or peripheral stimulation from sensory branch of the trigeminal nerve. In some cases, the effect can lead to severe bradycardia, asystole, and arterial hypotension that need interventions.

Case : We reported a case of 58 years old female who underwent tumor removal surgery in cerebellopontine angle area. The patient had two episodes of TCR. The first one was well handled by stopping the manipulation of surgery and was given sulfas atropine. In the second episodes of TCR, the patient had refractory bradycardia and led to asystole, then the patient was given adrenaline. We performed a cycle of cardiac resuscitation and the patient^s circulation returns spontaneously. Then, the patient was admitted to intensive care unit and was given continuous infusion of adrenaline and noradrenaline. After five days of hospitalizations, the patient was extubated and discharged, then scheduled for cranioplasty.

Discussion : The most important management of the TCR episodes is an early detection of bradycardia or hypotension with strict and continuous hemodynamic monitoring and to stop direct stimulus from all surgical manipulations.

Key word : Trigeminocardiac reflex, Cerebellopontin angle, Bradycardia, asystole

Keywords: Key word : Trigeminocardiac reflex, Cerebellopontin angle, Bradycardia, asystole

Topic: Update Emergency Assesment and Management