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Trigeminocardiac reflex in neurosurgical practice: An observational prospective study
Farhad Etezadi1, Amir Ali Orandi, Amir Hosein Orandi
1Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Surgical Neurology International
|October 2, 2013
Summary
Trigeminal-cardiac reflex (TCR) is rare during cranial surgery with standard anesthesia, occurring in 2.1% of patients. Maintaining adequate anesthesia depth with Cerebral State Index (CSI) monitoring is recommended.
Area of Science:
- Neurosurgery
- Anesthesiology
- Cardiology
Background:
- Trigeminal-cardiac reflex (TCR) incidence varies during cranial neurosurgery.
- Limited reliable data exists on TCR during these procedures.
- A prospective study was designed to investigate TCR incidence.
Purpose of the Study:
- To determine the incidence of TCR in patients undergoing cranial surgery.
- To evaluate TCR during standard general anesthesia for supra/infra-tentorial and skull base lesions.
- To assess the role of anesthesia depth in TCR occurrence.
Main Methods:
- 190 patients undergoing elective cranial surgery were enrolled.
- Standard general anesthesia with propofol-alfentanil and CSI monitoring (40-60) was used.
- TCR episodes (bradycardia/hypotension >20% decrease) were recorded.
Main Results:
- TCR occurred in 4 out of 190 patients (2.1%).
- Episodes were observed during skin suturing (CSI 70-77) and tumor sampling near the cavernous sinus (CSI 51).
- TCR is a rare event under standard anesthetic techniques.
Conclusions:
- Trigeminal-cardiac reflex is a rare complication during cranial neurosurgery with standard anesthesia.
- Maintaining adequate anesthesia depth, potentially monitored by CSI, is advisable throughout neurosurgical procedures.
