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A Case of Trigeminocardiac Reflex During Infrastructure Maxillectomy
Suresh Mohan1, Daniel W Flis2, Miriam A O'Leary2
1Medical student at Warren Alpert Medical School of Brown University, Providence, Rhode Island.
JAMA Otolaryngology-- Head & Neck Surgery
|May 3, 2014
Summary
The trigeminocardiac reflex, a sudden drop in heart rate and blood pressure during head and neck surgery, requires prompt recognition. Early intervention with stimulus removal and medication can prevent complications.
Area of Science:
- Neurology
- Cardiology
- Surgical Oncology
Background:
- The trigeminocardiac reflex (TCR) is a well-documented phenomenon involving bradycardia or asystole due to trigeminal nerve stimulation.
- While typically self-limiting, TCR can pose risks during head and neck procedures.
Observation:
- A case report details a patient experiencing asystole and bradycardia during a maxillectomy for squamous cell carcinoma.
- The reflex was triggered by manipulation of the posterior maxillary region.
Findings:
- Atropine administration and removal of the surgical stimulus effectively resolved the asystolic and bradycardic episodes.
- This highlights the efficacy of prompt intervention in managing TCR.
Implications:
- Surgeons and anesthesiologists must be vigilant for TCR during head, neck, and skull base surgeries involving trigeminal nerve manipulation.
- Preventative measures and rapid response, including anticholinergic use, are crucial for patient safety and successful surgical outcomes.
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