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Gupta B, Sabahi M, Santos RC, Srinivash Ramesh Babu Y, Santiago RACB, Dabecco R, Phang-Lyn S, Adada B, Borghei-Razavi H. Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:297. [PMID: 39004670 PMCID: PMC11247045 DOI: 10.1007/s00701-024-06178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes. METHODS We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery. RESULTS The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006). CONCLUSIONS Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.
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Affiliation(s)
- Bhavika Gupta
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Romel Corecha Santos
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | | | | | - Rocco Dabecco
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Simone Phang-Lyn
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA.
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Zhang H, Zhang M, Guo H, Liu M, He J, Li J. Risk factors associated with trigeminocardiac reflex in patients with trigeminal neuralgia during percutaneous balloon compression: A retrospective cohort study. Clin Neurol Neurosurg 2023; 231:107834. [PMID: 37331207 DOI: 10.1016/j.clineuro.2023.107834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The trigeminocardiac reflex (TCR) is a brainstem reflex commonly elicited during percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN), which is characterized by drastic hemodynamic disturbances, such as bradycardia, arrhythmias and even cardiac arrest. In order to prevent catastrophic consequences, it is vital to screen the risk factors of TCR during perioperative period. The primary purpose of this study was to identify potential risk factors associated with TCR in patients with TN undergoing PBC, and to summarize the enlightenment of clinical anesthesia management. METHODS The clinical data of 165 patients diagnosed with TN undergoing PBC from January 2021 to December 2021 were retrospectively analyzed. TCR was defined as a sudden decrease in heart rate of 20% or more compared with baseline, and / or cardiac arrest, coinciding with the stimulus of any branch of the trigeminal nerve. And a clear cause-effect relationship between heart rate reduction and PBC-related intervention was required. All demographic characteristics as well as surgical and anesthetic data were compared between TCR group and TCR-free group. Univariate and multivariate logistic regression analysis were used to further analyze TCR-related risk factors. RESULTS Of the 165 patients enrolled in this study, 73 (44.2%) were male and 92 (55.8%) were female, and the average age was 64.22 ± 9.72 years. The incidence of TCR in the patients with TN during PBC was 54.5%. The results of multivariate regression analysis indicated that the risk factor for TCR was heart rate < 60 beats/min immediately before foramen ovale puncture (OR: 4.622; 95%CI: 1.470-14.531; P < 0.05). CONCLUSION Heart rate < 60 beats/min immediately before foramen ovale puncture was independently associated with TCR. Therefore, it is necessary for anesthesiologists to raise heart rate appropriately to prevent TCR during PBC.
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Affiliation(s)
- Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Meng Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hongxia Guo
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
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Zhang H, He J, Du Y, Liu M, Li J. Prolonged asystole induced by trigeminocardiac reflex accompanied with abnormal heart rate variability during percutaneous balloon compression: a case report. J Int Med Res 2023; 51:3000605221148618. [PMID: 36650919 PMCID: PMC9869194 DOI: 10.1177/03000605221148618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Trigeminocardiac reflex (TCR) can result in bradycardia and even cardiac arrest, and is reversible with elimination of the stimulus. Here, we report the case of a 68-year-old man who experienced cardiac arrest during percutaneous balloon compression for the treatment of trigeminal neuralgia. In this patient, sinus rhythm did not recover after stimulation removal, causing us to successfully perform cardiopulmonary resuscitation (CPR). The patient regained a sinus rhythm and was pretreated with atropine 0.5 mg, allowing the operation to be started again. The operation was completed successfully and the patient experienced no complications. Subsequent heart rate variability (HRV) analysis showed that parasympathetic activity predominated before anesthesia induction and after tracheal intubation. It further elevated during foramen ovale puncture, leading to prolonged asystole. Fortunately, sympathetic activity predominated after atropine was administered, which manifested as an increase in sympathetic activity and a decrease in parasympathetic activity. This could be beneficial for patients with TCR. This case indicates that TCR-related cardiac arrest might not be reversed with stimulus cessation, and atropine played a key role in preventing TCR. Moreover, HRV analysis might be essential for preoperative screening for high-risk patients. We also reviewed the literature for cases of TCR with prolonged asystole.
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Affiliation(s)
| | | | | | | | - Jianli Li
- Jianli Li, Department of Anesthesiology, Hebei General Hospital, 348 Heping Road West, Shijiazhuang City, Hebei Province 050051, China.
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Zhang H, Liu M, Guo W, He J, Li J. The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study. Ther Clin Risk Manag 2022; 18:1091-1098. [DOI: 10.2147/tcrm.s373370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
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The Effect of Atropine on Trigeminocardiac Reflex-induced Hemodynamic Changes During Therapeutic Compression of the Trigeminal Ganglion. J Neurosurg Anesthesiol 2022; 34:e40-e45. [PMID: 32496449 DOI: 10.1097/ana.0000000000000702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous compression of the trigeminal ganglion (PCTG) can induce significant hemodynamic perturbations secondary to the trigeminocardiac reflex (TCR). The aim of this study was to investigate the effect of atropine pretreatment on hemodynamic responses during PCTG for trigeminal neuralgia. MATERIALS AND METHODS A total of 120 patients who received PCTG were randomly assigned to control and atropine groups that were pretreated with saline (n=60) and atropine 0.004 mg/kg intravenously (n=60), respectively. Heart rate (HR) and mean arterial pressure (MAP) were measured at 9 timepoints from before induction of anesthesia until the end of the PCTG procedure; the incidence of TCR was also observed. RESULTS HR was higher in the atropine compared with control group from the time of skin puncture with the PCTG needle until after the procedure was completed (P<0.05). MAP was also higher in the atropine compared with control group, but only at entry of the needle into the foramen ovale until 1 minute after trigeminal ganglion compression (P<0.05). HR was reduced in both groups during entry of the needle into the foramen ovale and during ganglion compression, but less so in the atropine compared with the control group (P<0.05). MAP increased during PCTG compared with baseline in both groups, but with a larger increase in the atropine group (P<0.05). Two and 52 cases in the control group, and 6 and 1 cases in the atropine group, exhibited a TCR during entry of the needle into the foramen ovale and at ganglion compression, respectively (P<0.05). CONCLUSION Pretreatment with atropine was effective in most patients at minimizing abrupt reduction in HR during PCTG.
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Huang B, Yao M, Chen Q, Du X, Li Z, Xie K, Fei Y, Do H, Qian X. Efficacy and Safety of Awake CT-guided Percutaneous Balloon Compression of Trigeminal Ganglion for Trigeminal Neuralgia. PAIN MEDICINE 2021; 22:2700-2707. [PMID: 34320638 DOI: 10.1093/pm/pnab228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To describe the method and clinical efficacy of awake CT-guided percutaneous balloon compression (PBC) as a treatment for trigeminal neuralgia (TN). DESIGN In this case-series, TN patients were treated with awake CT-guided PBC and followed for treatment efficacy and complications for 12 months. SETTING A single-center study. SUBJECTS 66 patients with medical treatment-refractory TN were recruited for the study. METHODS The procedure was performed under moderate sedation. A balloon catheter was inserted through a trocar needle to reach Meckel's cavity under CT-guidance. The position and optimal shape of the contrast-filled balloon was confirmed with CT 3-dimension reconstruction. Compression of the TG was considered completed when the patient notified operators about facial hypoesthesia or the resolution of TN symptoms. All patients were followed up monthly for 12 months to monitor treatment efficacy and complications. RESULTS The average TG compression time was 272±81 seconds, at which point the patients reported significant facial hypoesthesia comparing to the contralateral side or resolution of triggered pain in the affected area. All patients had resolution of TN symptoms for 6 months, with a 1-year recurrent rate of 13%. Overall safety profile is improved with the current technique. Side effects, such as hypoesthesia, and mastication weakness, were overall mild, and did not impact patients' quality-of-life. Some complications that were historically associated with PBC, such as diplopia and keratitis, were not present. CONCLUSIONS This new awake CT-guided PBC technique produces better outcomes than the traditional PBC under fluoroscopy-guidance and general anesthesia.
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Affiliation(s)
- Bing Huang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - Ming Yao
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Xindan Du
- Department of Pain Medicine, Hangzhou Red Cross Hospital, Hangzhou, 310006, China
| | - Zhang Li
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - Keyue Xie
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - Yong Fei
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - Huy Do
- Department of Interventional Neuroradiology, Stanford University, CA, 94063, USA
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, 94305, USA
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Qin Q, Wang Y. Recurrent trigeminocardiac reflex in percutaneous balloon compression for trigeminal neuralgia: A case report. Medicine (Baltimore) 2020; 99:e22467. [PMID: 33126301 PMCID: PMC7598812 DOI: 10.1097/md.0000000000022467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Trigeminocardiac reflex (TCR) sometimes occurs during the percutaneous balloon compression (PBC) procedure to treat trigeminal neuralgia (TN), and it manifests as transient bradycardia or sinus arrest. However, recurrent intraoperative TCR cases are rarely reported. Meanwhile, the treatment for recurrent TCR is still unclear. PATIENT CONCERNS A 74-year-old male with a 2-year TN history could no longer tolerate the side effects of carbamazepine and came to seek PBC treatment. DIAGNOSES Bradycardia or sinus arrest occurred repeatedly during the operation, and the heart rate (HR) rapidly returned to normal when the operation was suspended. The C-arm image showed the puncture needle entering the foramen ovale. INTERVENTIONS First, 0.5 mg atropine was administered twice, and then 1 mL of 2% lidocaine was injected locally at the puncture site. Finally, isoproterenol was continuously pumped and dynamically adjusted to maintain the HR above 90 bpm. OUTCOMES The use of atropine and lidocaine did not prevent the recurrence of TCR. The use of isoproterenol to maintain the HR enabled the successful completion of the operation. The patient recovered quickly after the operation and was discharged 2 days later. No complaints of discomfort were reported during the sixth-month follow-up. LESSONS The elimination of intraoperative TCR may be difficult. Maintaining a high HR intraoperatively by continuous isoproterenol infusion is effective for preventing or mitigating the onset of TCR.
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Affiliation(s)
- Qin Qin
- Department of Anesthesiology, Xiangya Second Hospital, Central South University, Changsha, Hunan
- Department of Anesthesiology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yaping Wang
- Department of Anesthesiology, Xiangya Second Hospital, Central South University, Changsha, Hunan
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The Effect of Depth of Anesthesia on Hemodynamic Changes Induced by Therapeutic Compression of the Trigeminal Ganglion. J Neurosurg Anesthesiol 2019; 32:344-348. [DOI: 10.1097/ana.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Borghei-Razavi H, Das P, Maurtua M, Recinos PF. Unusual Appearance of Trigemino-Cardiac Reflex During Cerebellopontine Angle Surgery. World Neurosurg 2018; 112:298-299. [PMID: 29580017 DOI: 10.1016/j.wneu.2017.10.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paramita Das
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marco Maurtua
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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Mendelson ZS, Velagala JR, Kohli G, Heir GM, Mammis A, Liu JK. Pain-Free Outcomes and Durability of Surgical Intervention for Trigeminal Neuralgia: A Comparison of Gamma Knife and Microvascular Decompression. World Neurosurg 2018; 112:e732-e746. [DOI: 10.1016/j.wneu.2018.01.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
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Wang CM, Guan ZY, Cai CH, Zhang J, Wang RW, Pang QG, Liu H. Comparative Study of Atropine Combined with Sodium Nitroprusside Pretreatment to Prevent Trigemino Cardiac Reflex after Trigeminal Ganglion Compression. J Clin Diagn Res 2016; 10:UC09-12. [PMID: 27134974 DOI: 10.7860/jcdr/2016/17095.7363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Manipulation of percutaneous compression of the trigeminal ganglion (PCTG) for trigeminal neuralgia (TN) can lead to significant haemodynamic changes, which were termed trigemino cardiac reflex (TCR). Nevertheless, many studies indicated that atropine pretreatment can reduce the incidence of bradycardia and cardiac arrest, but do not take precautions against abrupt rise of blood pressure. AIM The purpose of our study was to compare control group {patients receiving Sodium Nitro-Prusside (SNP) pretreatment before PCTG} with study groups (patients receiving different doses of atropine combined with SNP pretreatment before PCTG) in cardiovascular parameters {Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR)} at 5 periods during Total Intravenous Anaesthesia (TIVA). MATERIALS AND METHODS In total, 120 patients, who underwent PTCG, were enrolled and randomly assigned into control group {group A (SNP pretreatment before PCTG, n=29)} and study groups {group B (0.002mg /kg atropine combined with SNP pretreatment before PCTG, n=30), C (0.004mg/kg atropine pretreatment before PCTG, n=31) and D (0.006mg/kg atropine combined with SNP pretreatment before PCTG, n=30)}, the relationship between haemodynamic changes and using atropine pretreatment or not was compared. Cardiovascular parameters were measured at five periods: preoperative (T0); before puncture (T1); during compression (T2); 1 min after the compression ended (T3); and 1 min after the procedure ended (T4). Multivariate analysis of variance (MANOVA) and Pearson's χ(2) test were used, and a value of p < 0.05 was considered statistically significant. RESULTS Compared with the group A, means of SBP and DBP in the study groups (group B, C and D) were not observed significant differences at all time points (p>0.05), the mean values of HR showed significant differences, when compared to group C and group D at T2 and T3 (p<0.001). Meanwhile, means of SBP, DBP and HR comparison in the same group were observed between T1 and T2, to the group A, B and D, means of HR (p>0.05 vs. T1) indicated significant differences, however, there was no significant difference in group C (p>0.05). Furthermore, the incidence of post-compression tachycardia was observed in each group. CONCLUSION By comparison, it seemed that 0.004mg/kg atropine pretreatment before PCTG was more reasonable for preventing significant haemodynamic changes.
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Affiliation(s)
- Chang-Ming Wang
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
| | - Zhan-Ying Guan
- Department of Anesthesiology, Branch Hospital of Hunnan, The General, Hospital of Shen Yang Military Region , Shen Yang, China
| | - Chang-Hua Cai
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
| | - Jing Zhang
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
| | - Rong-Wei Wang
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
| | - Qing-Gui Pang
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
| | - Hui Liu
- Department of Anesthesiology, Liao Ning Provincial People's Hospital , Shen Yang, China
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Chowdhury T, Ahuja N, Schaller B. Severe Bradycardia During Neurosurgical Procedure: Depth of Anesthesia Matters and Leads to a New Surrogate Model of the Trigeminocardiac Reflex: A Case Report. Medicine (Baltimore) 2015; 94:e2118. [PMID: 26656339 PMCID: PMC5008484 DOI: 10.1097/md.0000000000002118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hemodynamic alterations are observed in various neurosurgical procedures and commonly related to different neurogenic mechanisms. However, anesthetic influences on causation of these perturbations or management are rarely investigated and therefore our present knowledge is still limited.In this case of 43-old Caucasian male, propofol boluses aborted the trigeminal cardiac reflex (TCR) induced severe bradycardia during dural manipulation. There is a correlation of severity of bradycardia and slightness of anesthesia.In the light of the larger distribution of the TCR all over the world, we see more and more aborted TCR, as seen in the present case; then the neuro-anesthesists more and more recognize the TCR at its very onset. A surrogate model for the daily use is present to underline the clinical needs.We have therefore developed, for the first time, a surrogate model that helps in daily practice to recognize and prevent TCR episodes.
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Affiliation(s)
- Tumul Chowdhury
- From the Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba (TC, NA); and Department of Research, University of Southampton, Southampton, UK (BS)
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Chowdhury T, Nöthen C, Filis A, Sandu N, Buchfelder M, Schaller B. Functional Outcome Changes in Surgery for Pituitary Adenomas After Intraoperative Occurrence of the Trigeminocardiac Reflex: First Description in a Retrospective Observational Study. Medicine (Baltimore) 2015; 94:e1463. [PMID: 26376385 PMCID: PMC4635799 DOI: 10.1097/md.0000000000001463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma. In a retrospective observational study, 19 out of 338 (8%) enrolled adult patients demonstrated a TCR during transsphenoidal/transcranial surgery for pituitary adenomas. The 2 subgroups (TCR vs non-TCR) had similar patient's characteristics, risk factors, and histology. Preoperatively, there was a similar distribution of normal pituitary function in the TCR and non-TCR subgroups. In this TCR subgroup, there was a significant decrease of that normal pituitary function after operation (37%) compared to the non-TCR group (60%) (P < 0.03). The TCR subgroup therefore demonstrated a 3.15 times (95%CI 1.15-8.68) higher risk for non-normalizing of postoperative pituitary function compared with the non-TCR subgroup (P < 0.03). It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice.
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Affiliation(s)
- T Chowdhury
- From the Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada (CT); Department of Neurosurgery, University of Erlangen-Nuremberg, Germany (NC, FA, BM), and Department of Research, University of Southampton, Southampton, UK (SN, SB)
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Meuwly C, Golanov E, Chowdhury T, Erne P, Schaller B. Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. Medicine (Baltimore) 2015; 94:e484. [PMID: 25654391 PMCID: PMC4602726 DOI: 10.1097/md.0000000000000484] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context. Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response. The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex. In this review, we highlighted criteria for proper definition and classification of the TCR in the light of increased knowledge and present a thinking model to overcome this complexity. Further we separately discussed the role of HR and MABP and their variation in this context. As another subtopic we gave attention to is the chronic TCR; a variant that is rarely seen in clinical medicine.
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Affiliation(s)
- C Meuwly
- From the University of Basel, Switzerland (CM); The Houston Methodist Research Institute, Houston, Texas, USA (EG); Department of Anesthesia and Perioperative Medicine. University of Manitoba, Winnipeg, Canada (TC); Cardiology, St Anna Clinic, Luzern, Switzerland and University of Basel, Switzerland (PE); Department of Research, University of Southampton, United Kingdom (BS); and Academic Editor, Medicine (BS)
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Comparative Study of Trigeminocardiac Reflex After Trigeminal Ganglion Compression During Total Intravenous Anesthesia. J Neurosurg Anesthesiol 2015; 27:16-20. [DOI: 10.1097/ana.0000000000000076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chowdhury T, Sandu N, Meuwly C, Cappellani RB, Schaller B. Trigeminocardiac reflex: differential behavior and risk factors in the course of the trigeminal nerve. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.13.62] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT; The trigeminocardiac reflex (TCR) is a brainstem reflex describing the acute hemodynamic perturbations in neurosurgical patients. The roles of different anatomic locations of this reflex arc on end responses have been found to be variable. In this article, we have highlighted the role and importance of different TCR pathway (peripheral vs central) mechanisms, their manifestations and the various risk factors associated with these. In addition, new insights into various other non-neurosurgical conditions, in special relation to neurointerventional procedures, are also presented in this article. This study is a narrative review based on a PubMed/Google search (from 1 January 1970 to 31 March 2013) on this topic. The common manifestations, such as hypotension and bradycardia, are vagal-dominated responses; however, unusual manifestations, such as hypertension and tachycardia, signify the involvement of the sympathetic nervous system. In addition, there is a complex interaction of the various sensory receptors at the Gasserian ganglion, and this is responsible for the different presentations. There are many surgical as well as nonsurgical risk factors associated with TCR. Interestingly, TCR may affect functional outcome and has been found to be involved in some normal physiological mechanisms, including bruxism. TCR is a complex neurophysiological reflex and there are variable presentations depending upon the peripheral or central stimulation surrounding the Gasserian ganglion. We suggest, for the first time, that if the TCR is initiated at the Gasserian ganglion, it reacts in a different manner from the better-known central or peripheral TCR.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesia & Perioperative Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Nora Sandu
- Research University of Southampton, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrill Meuwly
- University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Ronald B Cappellani
- Department of Anesthesia & Perioperative Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Bernhard Schaller
- Research University of Southampton, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
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