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La Corte E, Gelmi CAE, Bertolini G, Ruggiero F, Younus I, Sturiale C, Mazzatenta D, Conti A, Aspide R. Giuseppe Dagnini (1866-1928): Discoverer of the Trigemino-Cardiac Reflex and Practical Implications in Neurosurgery and Other Medical Specialties. World Neurosurg 2024; 186:116-121. [PMID: 38521222 DOI: 10.1016/j.wneu.2024.03.086] [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: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
The authors present the life and art of Giuseppe Dagnini, a renowned Italian physician who was born in Bologna in 1866. He was the chief of the Maggiore Hospital in Bologna and authored valuable scientific works on the trigemino-cardiac reflex which is still applied in modern clinical practice. Dr. Dagnini firstly described the reflex in 1908 postulating that stimulation of one of the 3 branches of the trigeminal nerve triggers the afferent pathway in lowering heart rate. The authors also provide a modern outlook on the clinical implications of the TCR in neurosurgery, neuroanesthesia, and other medical specialties.
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Affiliation(s)
- Emanuele La Corte
- Neurosurgery and Neurotraumatology Unit, Department of Neurosciences, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | - Giacomo Bertolini
- Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Ruggiero
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Maxillofacial Surgery Operative Unit, Bellaria-Maggiore Hospital, Azienda Unità Sanitaria Locale di Bologna, Italy
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carmelo Sturiale
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Yon Charles TZ, Leslie Hurrell MJ, Vujcich NJ, Mian M, Bobinskas AM. Oculocardiac reflex incidence in post-traumatic orbital reconstruction surgery. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Martinez-Ávila MC, Carrasquilla R, Oyola A, Rodriguez J, Castro-Dager A, Almeida Pérez R, De la Rosa G, Orozco-Gómez F, Quintero-Consuegra M. Cardiorespiratory Events in Children During Chemoembolization of Ophthalmic Artery for Retinoblastoma. Cureus 2021; 13:e16630. [PMID: 34466315 PMCID: PMC8396419 DOI: 10.7759/cureus.16630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/30/2022] Open
Abstract
Retinoblastoma (RB) is the most common eye neoplasm in childhood, accounting for 2.5% to 4% of all pediatric cancers. Recent approaches to treat RB include localized administration of chemotherapy, such as super-selective ophthalmic artery chemotherapy. Although localized chemotherapy aims that minimize systemic side effects, some adverse cardio-respiratory reactions have been described as associated with this therapy. Our case report describes the cardiorespiratory severe events presented secondary to super-selective chemotherapy of the ophthalmic artery, to which we must be prepared to avoid fatal outcomes
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Affiliation(s)
| | | | - Antonio Oyola
- Anesthesia and Critical Care, Neurodinamia, Cartagena, COL
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Leon-Ariza DS, Leon-Ariza JS, Gualdron MA, Bayona-Prieto J, Leon-Sarmiento FE. Territorial and Extraterritorial Trigeminocardiac Reflex: A Review for the Neurosurgeon and a Type IV Reflex Vignette. Cureus 2020; 12:e11646. [PMID: 33376657 PMCID: PMC7755611 DOI: 10.7759/cureus.11646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The trigeminocardiac reflex (TCR) is a complex and, sometimes, fatal event triggered by overstimulation of the trigeminal nerve (TN) and its territorial and spinal cord branches. We reviewed and compiled for the neurosurgeon key aspects of the TCR that include a novel and straightforward classification, as well as morphophysiology, pathophysiology, neuromonitoring and neuromodulation features. Further, we present intraoperative data from a patient who developed extraterritorial, or type IV, TCR while undergoing a cervical surgery. TCR complexity, severity and unwanted outcomes indicate that this event should not be underestimated or overlooked in the surgical room. Timely TCR recognition in surgical settings is valuable for applying effective intraoperative management to prevent catastrophic outcomes.
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Affiliation(s)
| | | | | | | | - Fidias E Leon-Sarmiento
- Environmental Health, Florida International University, Miami, USA.,Neurology, Baptist Health South Florida, Miami Neuroscience Institute, Miami, USA.,Internal Medicine, National University, Bogota, COL
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Li L, Lin C, Peña M, Challa C. Trigeminocardiac reflex in pediatric adenotonsillectomy: A report of two cases with literature review. Laryngoscope 2019; 130:803-805. [DOI: 10.1002/lary.28016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Lilun Li
- Department of OtolaryngologyChildren's National Health System Washington DC U.S.A
- Division of OtolaryngologyGeorge Washington University Washington DC U.S.A
| | - Connie Lin
- Division of Anesthesiology, Pain and Perioperative MedicineChildren's National Health System Washington DC U.S.A
- Department of AnesthesiologyGeorge Washington University Washington DC U.S.A
| | - Maria Peña
- Department of OtolaryngologyChildren's National Health System Washington DC U.S.A
- Division of OtolaryngologyGeorge Washington University Washington DC U.S.A
| | - Chaitanya Challa
- Division of Anesthesiology, Pain and Perioperative MedicineChildren's National Health System Washington DC U.S.A
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Chowdhury T, Rosemann T, Schaller B. Letter to the Editor Regarding "Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex: A Systematic Review". World Neurosurg 2018; 119:450. [PMID: 30347571 DOI: 10.1016/j.wneu.2018.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tumul Chowdhury
- Department of Anaesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas Rosemann
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zurich, Switzerland.
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Leon-Ariza DS, Leon-Ariza JS, Nangiana J, Vargas Grau G, Leon-Sarmiento FE, Quiñones-Hinojosa A. Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex: A Systematic Review. World Neurosurg 2018; 117:4-10. [DOI: 10.1016/j.wneu.2018.05.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
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Nghe MC, Godier A, Shaffii A, Leblanc I, Picard H, Blanc R, Lumbroso-Le Rouic L, Devys JM. Prospective analysis of serious cardiorespiratory events in children during ophthalmic artery chemotherapy for retinoblastoma under a deep standardized anesthesia. Paediatr Anaesth 2018; 28:120-126. [PMID: 29205669 DOI: 10.1111/pan.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Serious adverse cardiorespiratory events complicate super selective ophthalmic artery chemotherapy for retinoblastoma in anesthetized children. Their mechanism remains unclear but may be attributed to an autonomic nervous reflex induced by the catheter close to the ophthalmic artery. Inadequate depth of anesthesia during catheter stimulation might be an aggravating factor. Thus, we tested whether deep general anesthesia reduced the incidence of serious cardiorespiratory events. METHODS Children were prospectively included in this observational study. Standardized deep general anesthesia with sevoflurane, rocuronium, and sufentanil was administered. Sevoflurane MAC was kept between 1.5 and 1.7 and additional sufentanil administered. Serious cardiorespiratory event criteria were predefined and included arterial hypotension, bradycardia, and severe decrease in lung compliance. They were recorded and the factors influencing their occurrence were investigated. RESULTS One hundred fifteen procedures were performed on 32 children. The median MAC of sevoflurane was 1.5 and median BIS value was 44. Serious cardiorespiratory events occurred in 20% of procedures and were mainly severe decrease in lung compliance (83% of events). All of them required active treatment. One procedure was aborted due to cardiorespiratory compromise and required an epinephrine infusion. All severe decreases in lung compliance occurred within 2 minutes after catheter insertion in the ophthalmic artery. No recorded demographic and endovascular characteristics were associated with serious cardiorespiratory events. CONCLUSION Serious cardiorespiratory events occur commonly during super selective ophthalmic artery chemotherapy. Standardized deep anesthesia with analgesia did not appear to be protective. No predictive factors were identified, but these events systematically arose within 2 minutes after ophthalmic artery catheter insertion. Anesthetists and neuroradiologists should be prepared to manage these serious complications and parents should be informed of the risks.
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Affiliation(s)
- Marie-Claire Nghe
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Anne Godier
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France.,INSERM UMR-S1140, Paris Descartes University, Paris, France
| | - Anoushée Shaffii
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Isabelle Leblanc
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Hervé Picard
- Clinical Research Unit, Foundation Adolphe de Rothschild, Paris, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Foundation Adolphe de Rothschild, Paris, France
| | | | - Jean-Michel Devys
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
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Meuwly C, Chowdhury T, Sandu N, Golanov E, Erne P, Rosemann T, Schaller B. Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update. Front Neurol 2017; 8:533. [PMID: 29085328 PMCID: PMC5649131 DOI: 10.3389/fneur.2017.00533] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022] Open
Abstract
Background The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR in 1999, there is an ongoing discussion about a more emergent clinical definition. In this work, the author worked out an approach to such an improved definition. Methods In this study, a grounded theory approach was used. Literature about TCR was systematically identified through PubMed (MEDLINE), EMBASE (Ovid SP), and ISI Web of Sciences databases from 1/2005 until 8/2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. A grounded theory approach was used to analyze and interpret the data through a synthesis by the researcher’s perspectives, values, and positions. Results Out of the included studies, the authors formed available data to an update of the understanding of changes in hemodynamic parameters (HR and blood pressure) in a TCR. According to this update, an HR deceleration should be a constant observation to identify a TCR episode while a drop in blood pressure should probably not being fixed to a certain percentage of decrease. Conclusion The here presented working definition improves our understanding of the TCR. It leads the way to a new understanding of the TCR for a proper clinical definition.
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Affiliation(s)
| | - Tumul Chowdhury
- Department of Anaesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nora Sandu
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
| | - Eugene Golanov
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, United States
| | - Paul Erne
- University Hospital Basel, Basel, Switzerland
| | - Thomas Rosemann
- Department of Primary Care, University of Zurich, Zürich, Switzerland
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zürich, Switzerland
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Sandu N, Chowdhury T, Meuwly C, Schaller B. Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis. Expert Rev Cardiovasc Ther 2017; 15:203-209. [DOI: 10.1080/14779072.2017.1286983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nora Sandu
- Department of Research, University of Southampton, Southampton, UK
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba (UOM)/Winnipeg Regional Health Authority (WRHA), Winnipeg, Manitoba, Canada
| | | | - Bernhard Schaller
- Department of Research, University of Southampton, Southampton, UK
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
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Singh GP, Chowdhury T, Bindu B, Schaller B. Sudden Infant Death Syndrome - Role of Trigeminocardiac Reflex: A Review. Front Neurol 2016; 7:221. [PMID: 27994573 PMCID: PMC5136573 DOI: 10.3389/fneur.2016.00221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/22/2016] [Indexed: 11/13/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is an unexplained death in infants, which usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR), is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex that manifests as bradycardia, hypotension, apnea, and gastric hypermotility. The TCR shares many similarities with the DR, which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath holding (apnea), bradycardia, and vasoconstriction, leading to increase in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation, or decreased neuronal density of arcuate nucleus, hypoplasia, and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field.
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Affiliation(s)
- Gyaninder Pal Singh
- Department of Neuro-Anesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba , Winnipeg, MB , Canada
| | - Barkha Bindu
- Department of Neuro-Anesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Bernhard Schaller
- Department of Research, University of Southampton , Southampton , UK
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Squier W, Mack J, Jansen AC. Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms. Dev Med Child Neurol 2016; 58:1223-1234. [PMID: 27435495 DOI: 10.1111/dmcn.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/01/2023]
Abstract
The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.
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Affiliation(s)
- Waney Squier
- Formerly Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK
| | - Julie Mack
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Anna C Jansen
- Paediatric Neurology Unit, Department of Paediatrics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Vrije Universiteit Brussel, Brussels, Belgium
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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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Sandu N, Chowdhury T, Schaller BJ. How to apply case reports in clinical practice using surrogate models via example of the trigeminocardiac reflex. J Med Case Rep 2016; 10:84. [PMID: 27048202 PMCID: PMC4822233 DOI: 10.1186/s13256-016-0849-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/25/2016] [Indexed: 12/04/2022] Open
Abstract
Case reports are an increasing source of evidence in clinical medicine. Until a few years ago, such case reports were emerged into systematic reviews and nowadays they are often fitted to the development of clinical (thinking) models. We describe this modern progress of knowledge creation by the example of the trigeminocardiac reflex that was first described in 1999 by a case series and was developed over the cause-and-effect relationship, triangulation to systematic reviews and finally to thinking models. Therefore, this editorial not only underlines the increasing and outstanding importance of (unique) case reports in current science, but also in current clinical decision-making and therefore also that of specific journals like the Journal of Medical Case Reports.
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Affiliation(s)
- Nora Sandu
- Departement of Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Bernhard J Schaller
- Departement of Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
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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, Chowdhury T, Sandu N, Reck M, Erne P, Schaller B. Anesthetic influence on occurrence and treatment of the trigemino-cardiac reflex: a systematic literature review. Medicine (Baltimore) 2015; 94:e807. [PMID: 25950688 PMCID: PMC4602521 DOI: 10.1097/md.0000000000000807] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmia including hypotension, apnea, and gastric hypermotility during stimulation of any branches of the trigeminal nerve. Previous publications imply a relation between TCR and depth of anesthesia. To gain more detailed insights into this hypothesis, we performed a systematic literature review.Literature about occurrence of TCR was systematically identified through searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (MEDLINE), EMBASE (Ovid SP), and the Institute for Scientific Information (ISI Web of Sciences) databases until June 2013, as well as reference lists of articles for risk calculation. In this study, TCR was defined as drop in mean arterial blood pressure and heart rate, both >20% to baseline. We calculated intraoperative cerebral state index (CSI) of each TCR-case using a newly developed method. These data were further divided into 3 subgroups: CSI <40 (deep anesthesia), CSI 40-60 (regular anesthesia), and CSI >60 (slight anesthesia).Including 45 studies with 910 patients, 140 (15%) presented with TCR, and 770 (85%) without TCR during operation. TCR occurrence showed a 1.2-fold higher pooled risk slighter anesthesia (CSI <40: 13%, at CSI 40-60: 21%, and at CSI >60: 27%) compared with deeper anesthesia. In addition, we could discover a 1.3-fold higher pooled risk of higher MABP drop with a strong negative correlation (r = -0.935; r = 0.89) and a 4.5-fold higher pooled risk of asystole during TCR under slight anesthesia compared with deeper anesthesia.Our work is the first systematic review about TCR and demonstrates clear evidence for TCR occurrence and a more severe course of the TCR in slight anesthesia underlying the importance of skills in anesthesia management during skull base surgery. Furthermore, we have introduced a new standard method to calculate the depth of anesthesia.
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Affiliation(s)
- Cyrill Meuwly
- From the University Hospital, 4031 Basel, Switzerland (CM, MR); Cardiology Luzerner Kantonsspital, 6000 Luzern, Switzerland (PE); Present address: Cardiology, St Anna Clinic, St Anna Strasse 32, 6006 Luzern, Switzerland (PE); Departments of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada (TC); and Department of Research, University of Southampton, Southampton, UK (NS, BS)
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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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Sandu N, Chowdhury T, Sadr-Eshkevari P, Filis A, Arasho B, Spiriev T, Schaller B. Trigeminocardiac reflex during cerebellopontine angle surgery: anatomical location as a new risk factor. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.14.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Aim: Trigeminocardicac reflex (TCR), a brainstem reflex, can be manifested in almost all types of surgery in the head and neck region. Patients & methods: Retrospective review of 125 patients operated on cerebellopontine angle (CPA) tumors according to strict inclusion/exclusion criteria. Results: A total of 14 out of 125 patients showed TCR during CPA tumor operation. In total, 29% of those patients presented with a meningioma located exclusively premeatal, but not retromeatal in the CPA. There was significant relationship between meningiomas subgroups and TCR (Barnard test; p < 0.05). Conclusion: Anatomical location may represent an important, but not yet described risk factor for the TCR having therefore an important role in the understanding of the TCR.
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Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Paris, Paris, France
| | - Tumul Chowdhury
- Department of Anesthesia, University of Manitoba, Winnipeg, Canada
| | | | - Andreas Filis
- Department of Neurosurgery, University of Erlangen, Erlangen, Germany
| | - Belachew Arasho
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Toma Spiriev
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Bernhard Schaller
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
- Department of Neuroanatomy, University of Pecs, Pecs, Hungary
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