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The nasocardiac reflex during nasoendoscopy: A commonly overlooked risk
Arthur Wong1, Mohd Zulkiflee Abu Bakar1
1Department of Otorhinolaryngology, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia.
American Journal of Otolaryngology
|January 11, 2021
Summary
The nasocardiac reflex causes a rapid heart rate drop during nasoendoscopy, though most patients remain asymptomatic. Electrical cardiac monitoring is recommended for vasovagal responses during endonasal procedures.
Area of Science:
- Physiology
- Cardiology
- Otolaryngology
Background:
- The nasocardiac reflex, a known but under-researched phenomenon, involves cardiac responses to nasal stimulation.
- Understanding its electrocardiographic features and heart rhythm dynamics during nasoendoscopy is crucial for patient safety.
Purpose of the Study:
- To determine the electrocardiographic characteristics of the nasocardiac reflex.
- To map heart rhythm changes during nasoendoscopy.
- To identify factors influencing the reflex's occurrence.
Main Methods:
- A prospective, quasi-experimental study involving 53 healthy subjects.
- Electrocardiographic monitoring for 60 seconds across baseline, nasoendoscopic, and recovery phases.
- Analysis of heart rate fluctuations and correlation with potential influencing variables.
Main Results:
- A significant decrease in heart rate was observed during nasoendoscopy (81.0 to 72.7 bpm).
- Sixteen subjects (30.2%) exhibited a positive nasocardiac reflex, maintaining sinus rhythm without significant arrhythmias.
- No variables were identified as affecting the incidence of the nasocardiac reflex in this cohort.
Conclusions:
- Nasoendoscopy consistently elicits a rapid heart rate reduction, with partial recovery post-procedure.
- While generally asymptomatic, severe nasocardiac reflexes pose potential risks during nasoendoscopy.
- Continuous electrical cardiac monitoring is advised for managing vasovagal responses in endonasal procedures.
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