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[Delayed trigeminocardiac reflex after maxillofacial surgery: case report].

Alexandre Almeida Guedes1, Felipe Ladeira Pereira2, Eric Guimarães Machado3

  • 1Universidade Federal de Juiz de Fora (UFJF), CET-SBA do Hospital Universitário, Juiz de Fora, MG, Brasil; Faculdade de Medicina de Barbacena, Barbacena, MG, Brasil.

Brazilian Journal of Anesthesiology (Elsevier)
|January 23, 2019
PubMed
Summary

The trigeminocardiac reflex, a response involving the trigeminal nerve, can cause severe symptoms during head and neck surgery. Prompt removal of nasal packing successfully resolved an exaggerated trigeminocardiac reflex in a surgical patient.

Keywords:
Cirurgia ortognáticaNervo trigêmeoOrthognathic surgeryReflexo trigêmino‐cardíacoTrigeminal nerveTrigeminocardiac reflex

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Area of Science:

  • Neurology
  • Anesthesiology
  • Otorhinolaryngology

Background:

  • The trigeminocardiac reflex (TCR) is a known physiological response during head and neck procedures.
  • While typically benign, TCR can manifest with severe, exaggerated responses, leading to significant patient morbidity.

Observation:

  • A 26-year-old male patient developed acute respiratory distress, bradycardia, and hypotension post-operatively after zygomatic-orbital complex fracture repair.
  • Symptoms included desaturation, dyspnea, wheezing, and hypotension unresponsive to atropine, suggesting an exaggerated TCR.
  • Complete resolution of symptoms occurred immediately following the removal of bilateral nasal packing.

Findings:

  • This case highlights an unusual presentation of an exaggerated trigeminocardiac reflex triggered by nasal packing.
  • The successful management by removing nasal packing underscores the importance of considering TCR in unexplained post-operative cardiorespiratory compromise.
  • Kratschmer's reflex, involving the trigeminal nerve, influences respiration and circulation, with potential for bradycardia, hypotension, and apnea.

Implications:

  • Close collaboration between surgeons and anesthesiologists is crucial for prompt diagnosis and management of TCR.
  • Careful monitoring of vital signs during and after head and neck surgery is essential to detect and manage exaggerated TCR.
  • Understanding and recognizing TCR can prevent severe complications and improve patient outcomes in neurosurgery and anesthesia.