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Maurya H, Singh V, Mohammad S, Singh G, Aggrawal A, Gautam S, Tiwari T. Perioperative trigeminocardiac reflex in patients undergoing surgical treatment of temporomandibular joint ankylosis: A study. Natl J Maxillofac Surg 2022; 13:248-253. [PMID: 36051797 PMCID: PMC9426709 DOI: 10.4103/njms.njms_334_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/10/2021] [Accepted: 07/23/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose The behavior of trigeminocardiac reflex (TCR) is limited to few case reports only in maxillofacial surgery, especially for temporomandibular joint (TMJ) ankylosis cases. The present study aims to find out the incidence of bradycardia due to TCR during intraoperative forceful mouth opening in TMJ ankylosis patients. Materials and Methods A prospective, unicentric observational study was conducted selecting those patients who were planned for osteoarthrectomy with interpositional gap arthroplasty under general anesthesia. Sixty cases of TMJ ankylosis were randomly selected from December 2018 to-03-2020. Predictor variables were patient age, gender, and type of ankylosis, and outcome variables were pulse rate, mean arterial blood pressure (MABP), and oxygen saturation level (SPO2). Data were recorded at baseline and during intraoperative mouth opening via heister jaw stretcher. A Chi-square test was used for testing the association between variables. P values were considered statistically significant at <0.05. Results The sample size of 60 subjects has been divided into two age groups (10-19) years and (20-40) years. The mean standard deviation age of the patients was 18.32 ± 6.81 years. About 63.3% were male. Out of 60 cases, 14 patients developed bradycardia. The frequency of bradycardia was found 23.3%. According to logistic regression analysis, age and type of ankylosis were the significant predictors of bradycardia. Conclusion We conclude that bradycardia due to TCR in TMJ ankylosis patients is not an uncommon entity. Incidences are more prevalent in the age group of 10-19 years and type IV bony ankylosis. Male had a high incidence of bradycardia though P value was nonsignificant.
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Affiliation(s)
- Harshita Maurya
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vibha Singh
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Vibha Singh, Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail:
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amiya Aggrawal
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesia and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anaesthesia and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Khalifa GA, Abd-Elmoniem MF, Mohamed FI. The trigeminocardiac reflex: Does the activation pathway of its efferent arc affect the intensity of the hemodynamic drop during the management of maxillofacial fractures? J Craniomaxillofac Surg 2021; 49:394-402. [PMID: 33632536 DOI: 10.1016/j.jcms.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/18/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022] Open
Abstract
The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type. There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated. 1Introduction.
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Affiliation(s)
- Ghada Amin Khalifa
- Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Qassim University, Saudi Arabia; Dental Medicine for Girls, Al Azhar University, 11727, Nasr City, Cairo, Egypt.
| | - Manal Foad Abd-Elmoniem
- Anaesthesia, Intensive Care, and Pain, Faculty of Medicine for Girls, Al Azhar University, 11727, Nasr City, Cairo, Egypt.
| | - Fatma Ibrahim Mohamed
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Deraya University, Minya, Egypt; Dental Medicine for Girls, Al Azhar University, 11727, Nasr City, Cairo, Egypt.
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Sugiyama S, Iwai T, Honda K, Mitsudo K. Trigeminocardiac reflex during bilateral sagittal split osteotomy. J Dent Sci 2020; 16:782-783. [PMID: 33854735 PMCID: PMC8025134 DOI: 10.1016/j.jds.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/23/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Japan
| | - Koji Honda
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Japan
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Kim H. Sudden arrhythmia followed by bradycardia during sagittal split ramus osteotomy: trigeminocardiac reflex. BMJ Case Rep 2019; 12:12/12/e232784. [PMID: 31796445 DOI: 10.1136/bcr-2019-232784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Trigeminocardiac reflex (TCR) is a brainstem reflex triggered by the stimulation of any branch of the fifth cranial nerve along its course, presenting as a reduction in heart rate and blood pressure. Oculocardiac reflex is a well-known subtype of TCR. In the case reported here, remarkable arrhythmia followed by bradycardia occurred suddenly in a healthy patient undergoing orthognathic surgery. The heart rhythm recovered when the surgical manipulation ceased, but bradycardia was reproduced when the surgery resumed. This case of TCR is unique in that remarkable arrhythmia first appeared and led to bradycardia; accordingly, intravenous lidocaine and an anticholinergic agent were administered simultaneously instead of anticholinergic agents alone, and were protective. Although TCR rarely occurs during orthognathic surgery, clinicians should be aware of its possibility and able to judge and manage it promptly.
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Affiliation(s)
- Hyunjee Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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De Verbizier C, Denis F, Moussa-Badran S, Sébastien L, Clara B. Pilot study in France about the infiltration of local anaesthetics associated to oral surgery procedures performed under general anaesthesia. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2018041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Opinions differ regarding the combined use of local anaesthesia (LA) and general anaesthesia (GA) in oral surgery procedures. The aim of this study was to evaluate practices in France concerning intraoperative LA for oral surgery performed under GA. Practitioners and method: We conducted a prospective survey of 250 oral surgery practitioners (CNIL-2045135v0 e) and carried out a literature review with the MEDLINE search engine (PubMed) covering the period from January 2000 to September 2017. Results: Among the 77 practitioners who participated, 88.3% were dental practitioners, the majority of whom were in the 25–34-yr age group. More than half (59%) infiltrated the surgical site; 46% pre-operatively, 24% intraoperatively and 11% post-operatively. Discussion: LA under GA appears to have advantages for post-operative pain management, dissection of the first mucosal plane and bleeding management pre- and post-operatively. The contraindications remain the same as for patients in a vigilant state. In children, it should be used in moderation to limit the risk of self-inflicted lip or mouth trauma during recovery. Conclusion: The indications of LA under GA are operator-dependent and the analysis of the literature did not allow us to determine the interest or not of LA administered intraoperatively during oral surgery performed under GA.
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Abdel-Hameed Elsayed S, Hegab AF, Youssif Alkatsh SS. Does Surgical Release of TMJ Bony Ankylosis Increase the Risk of Trigeminocardiac Reflex? A Retrospective Cohort Study. J Oral Maxillofac Surg 2018; 77:391-397. [PMID: 30712536 DOI: 10.1016/j.joms.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The exact frequency of the trigeminocardiac (TGC) reflex in temporomandibular joint (TMJ) surgery is still controversial. The purpose of the present report was to estimate the frequency of and identify the risk factors for TGC reflex among patients undergoing operative management of TMJ ankyloses. PATIENTS AND METHODS A retrospective cohort study was conducted of patients who had undergone gap arthroplasty for TMJ ankyloses at Al-Azhar University Hospital, Cairo, Egypt, from 2001 to 2015. The predictor variables were patient demographic data (age and sex), ankylosis type, and surgery type. The outcome variable was the occurrence of the TGC reflex (yes vs no). The data analysis included descriptive statistics and χ2 tests to compare the categorical variables. Binary regression logistic model analysis was performed to identify the associated predictor variable. P values were considered statistically significant at ≤ .05. RESULTS The sample included 55 subjects. The mean ± standard deviation age of the patients was 21.3 ± 9.855 years, and 43.6% were males. The frequency of TGC reflex was 12.7%. The factors associated with an increased risk of TGC reflex were type IV bony ankylosis (P = .012) and the need for repeat surgery (P = .016.). A multivariable binary regression model analysis demonstrated that the recurrence of surgery was the most significant predictor factor affecting the frequency of the TGC reflex. The computed variance ranged from 13 to 25%. However, other variables, including age, gender, side, and ankylosis type, were not associated with reflex onset (odds ratio, 0.028; 95% confidence interval, 0.001 to 0.911; P = .044). CONCLUSIONS Recurrent ankylosis surgery carries a high risk of TGC reflex. Preoperative risk factor identification and close monitoring are crucial to prevent the occurrence of this reflex in susceptible patients. Future research projects should include more variables in the study.
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Affiliation(s)
- Shadia Abdel-Hameed Elsayed
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Dental College and Hospital, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia; and Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University (Girls Branch), Cairo, Egypt.
| | - Ayman F Hegab
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Saeed Salem Youssif Alkatsh
- Lecturer, Department of Anaesthesia and Intensive Care, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
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Minami‐Sugaya H, Lentini‐Oliveira DA, Carvalho FR, Machado MAC, Marzola C, Saconato H, Prado GF. WITHDRAWN: Treatments for adults with prominent lower front teeth. Cochrane Database Syst Rev 2018; 5:CD006963. [PMID: 29791019 PMCID: PMC6494428 DOI: 10.1002/14651858.cd006963.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prominent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. The individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth. OBJECTIVES The purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults. SEARCH METHODS The following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012). SELECTION CRITERIA All randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. The mean differences with 95% confidence intervals were calculated for continuous data. MAIN RESULTS Two randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. The trials did not provide adequate data for assessing effectiveness of the techniques described. AUTHORS' CONCLUSIONS There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required.
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Affiliation(s)
- Hideko Minami‐Sugaya
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Débora A Lentini‐Oliveira
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Fernando R Carvalho
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Marco Antonio C Machado
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Clóvis Marzola
- Faculty of Odontology of Bauru, University of São PauloDepartment of SurgeryPedroso Alvarenga 772/71São PauloItaim BibiBrazil04531‐002
| | - Humberto Saconato
- Santa Casa de Campo MourãoDepartment of MedicineBR 158 Saída para Peabiru, 2761Campo MourãoCampo MourãoBrazil87309‐650
| | - Gilmar F Prado
- Escola Paulista de Medicina, Universidade Federal de São PauloDepartment of NeurologySão PauloSão PauloBrazil
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Occurrence of trigeminocardiac reflex during dental implant surgery: An observational prospective study. J Formos Med Assoc 2017; 116:742-747. [DOI: 10.1016/j.jfma.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 11/15/2022] Open
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Chowdhury T, Sandu N, Gelpi R, Schaller B. Trigeminocardiac reflex: beyond a skull base reflex. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology & Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nora Sandu
- Department of Research, University of Southampton, Southampton, UK
| | - Ricardo Gelpi
- Department of Pathology, University of Buenos Aires, Argentina
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Kiani M, Tajik G, Ajami M, Fazli H, Kharazifard M, Mesgarzadeh A. Trigeminocardiac reflex and haemodynamic changes during Le Fort I osteotomy. Int J Oral Maxillofac Surg 2016; 45:567-70. [DOI: 10.1016/j.ijom.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/05/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
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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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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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Sadr-Eshkevari P, Schaller BJ, Bohluli B. Trigeminocardiac reflex: Some thought to the definition. Surg Neurol Int 2014; 5:43. [PMID: 24818050 PMCID: PMC4014824 DOI: 10.4103/2152-7806.129617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/18/2014] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pooyan Sadr-Eshkevari
- Professional Program for International Dentists, University of California, Los Angeles, USA
| | | | - Behnam Bohluli
- Craniomaxillofacial Research Center, Azad University; Tehran, Iran
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Rashad A, Smeets R, Rana M, Bohluli B. Extraction bradycardia: a pilot case-crossover study. Head Face Med 2013; 9:29. [PMID: 24456612 PMCID: PMC3854007 DOI: 10.1186/1746-160x-9-29] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
Purpose Significant vasovagal reaction is one of the untoward events in the course of simple extractions. The present study then aimed to record the patients’ heart rate during the extraction procedure. Materials and methods Informed consents were obtained in advance. Patients were placed in the dental chair and their heart rate was measured before /and prior to the anesthetic injection, during, and after dental extraction on a pulse oxymeter device. Data were analyzed using paired t-test. Results Sixty one patients were included. The mean heart rates of these patients prior, during, and after extraction were 88, 86 and 81, respectively. Two by two comparisons showed a significant decrease in the mean heart rate during extraction compared to the baseline and also after extraction compared to both before and during extraction (p < 0.05 for all three). Conclusions Despite the presence of sufficient local anesthesia and performing the extraction with the least trauma, a significant decrease in heart rate is evident.
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Bhargava D, Thomas S, Chakravorty N, Dutt A. Trigeminocardiac Reflex: A Reappraisal with Relevance to Maxillofacial Surgery. J Maxillofac Oral Surg 2013. [PMID: 26224999 DOI: 10.1007/s12663-013-0541-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this paper was to undertake a review of literature on trigeminocardiac reflex in oral and maxillofacial online data-base and discuss the pathophysiology, risk factor assessment, presentation of the reflex, prevention, management with emphasis on the role of the attending anaesthetist and the maxillofacial surgeon. MATERIALS AND METHODS The available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review published clinical papers, abstracts and evidence based reviews on trigeminocardiac reflex relevant to oral and maxillofacial surgery. RESULTS Sixty-five articles were found with the search term "trigeminocardiac reflex" in the literature searched. Eighteen articles met the inclusion criteria for this study. The relevant data was extracted, tabulated and reviewed to draw evidence based conclusions for the management of trigeminocardiac reflex. CONCLUSIONS Conclusions were drawn and discussed based on the reviewed maxillofacial literature with emphasis on the anaesthetist's and the surgeon's role in the management of this detrimental event in maxillofacial surgical practice.
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Affiliation(s)
- Darpan Bhargava
- Department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences and Research Center, Peoples University, Bhanpur, Bhopal, M.P. India
| | - Shaji Thomas
- Department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences and Research Center, Peoples University, Bhanpur, Bhopal, M.P. India
| | - Nupur Chakravorty
- Department of Anesthesiology, L.N Medical College and Research Center and J.K Hospital, J.K Town, Sarvdharm C-Sector, Kolar Road, Bhopal, M.P. India
| | - Ashutosh Dutt
- Department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences and Research Center, Peoples University, Bhanpur, Bhopal, M.P. India
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Kim BB, Qaqish C, Frangos J, Caccamese JF. Oculocardiac Reflex Induced by an Orbital Floor Fracture: Report of a Case and Review of the Literature. J Oral Maxillofac Surg 2012; 70:2614-9. [DOI: 10.1016/j.joms.2012.06.189] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 06/24/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
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Minami-Sugaya H, Lentini-Oliveira DA, Carvalho FR, Machado MAC, Marzola C, Saconato H, Prado GF. Treatments for adults with prominent lower front teeth. Cochrane Database Syst Rev 2012:CD006963. [PMID: 22592716 DOI: 10.1002/14651858.cd006963.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prominent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. The individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth. OBJECTIVES The purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults. SEARCH METHODS The following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012). SELECTION CRITERIA All randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. The mean differences with 95% confidence intervals were calculated for continuous data. MAIN RESULTS Two randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. The trials did not provide adequate data for assessing effectiveness of the techniques described. AUTHORS' CONCLUSIONS There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required.
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Affiliation(s)
- Hideko Minami-Sugaya
- Neuro-Sono Sleep Center,Department of Neurology, Federal University of São Paulo, São Paulo - SP, Brazil.
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Bohluli B, Sadr-Eshkevari P, Rashad A, Schaller B, Maurer P. In reply. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abdulazim A, Prochnow N, Taeihagh T. TCR or not TCR? J Oral Maxillofac Surg 2011; 69:2483-4; author reply 2484-5. [PMID: 21939808 DOI: 10.1016/j.joms.2011.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 11/29/2022]
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