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[Trigemino-cardiac reflex in skull base surgery]
1Department of Neurosurgery, Peking University First Hospital, Beijing 100034, China.
Summary
Trigemino-cardiac reflex (TCR) during skull base surgery involves a sudden drop in blood pressure and heart rate due to trigeminal nerve manipulation. Prompt recognition and management ensure a good prognosis for patients.
Area of Science:
- Neurosurgery
- Anesthesiology
- Cardiology
Background:
- The Trigemino-cardiac reflex (TCR) is a known complication during skull base operations.
- Understanding its incidence, triggers, and management is crucial for patient safety.
Purpose of the Study:
- To investigate the mechanism, clinical features, and prognosis of TCR in patients undergoing skull base surgery.
- To identify factors influencing TCR occurrence and outcomes.
Main Methods:
- Retrospective analysis of 291 patients with skull base disease from Jan. 2009 to Oct. 2015.
- Identification and analysis of patients experiencing TCR during surgery, including triggers, physiological changes, and interventions.
Main Results:
- Nine patients experienced 19 instances of TCR during skull base surgery.
- TCR was triggered by manipulation, retraction, or stimulation of the trigeminal nerve, causing significant drops in heart rate and mean arterial blood pressure.
- Interventions like stopping stimulation, atropine, ephedrine, epinephrine, or dopamine effectively managed TCR, with no immediate postoperative complications.
Conclusions:
- TCR is a transient neural reflex characterized by bradycardia and hypotension during trigeminal nerve manipulation in skull base surgery.
- Accurate identification, vigilant monitoring, and appropriate management of TCR are essential for favorable patient outcomes.
