Bezold-Jarisch reflex in postoperative pediatric cardiac surgical patients

Area of Science:

• Cardiology
• Pediatric Surgery
• Neuroscience

Background:

• The Bezold-Jarisch reflex is an inhibitory reflex originating in the heart, mediated by the vagus nerve, leading to hypotension and bradycardia.
• Pediatric cardiac surgical patients are susceptible to various postoperative complications.

Observation:

• Four pediatric patients (1 day to 9 months old) experienced cardiovascular collapse post-surgery.
• Deterioration presented as a gradual drop in blood pressure without changes in heart rate, central venous pressure, or airway pressure.
• Bradycardia occurred subsequent to the observed hypotension.

Findings:

• The Bezold-Jarisch reflex was suspected as the cause of cardiovascular collapse.
• Administration of atropine, initially as a bolus (0.01 mg/kg) and then as a continuous infusion (0.01 mg.kg-1.h-1), successfully prevented recurrent episodes.
• Atropine treatment resolved the hypotension and bradycardia in these pediatric patients.

Implications:

• The Bezold-Jarisch reflex may be a more frequent cause of cardiovascular instability in postoperative pediatric cardiac surgical patients than currently recognized.
• Early recognition and prompt treatment with atropine can effectively manage Bezold-Jarisch reflex-induced complications.
• This study highlights the importance of considering neuro-cardiogenic reflexes in the management of pediatric cardiac surgical patients.