Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
01 07 2023
01 07 2023
Historique:
medline:
30
6
2023
pubmed:
3
5
2023
entrez:
3
5
2023
Statut:
ppublish
Résumé
The trigeminocardiac reflex is a common but underreported occurrence that can vary from benign to life threatening. This reflex can be elicited by placing direct pressure on the globe of the eye or from traction of the extraocular muscles, stimulating the trigeminal nerve. To provide a review of potential stimuli for the trigeminocardiac reflex within dermatologic surgery and to discuss management options for the treatment of the trigeminocardiac reflex. PubMed and Cochrane were used to identify articles and case reports that established scenarios in which the trigeminocardiac reflex was provoked and subsequently how the reflex was managed. Within the field of dermatologic surgery, the trigeminocardiac reflex can be stimulated during biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions, most often occurring in an office setting. The most common presentations include significant bradycardia, hypotension, gastric hypermobility, and lightheadedness. The most definitive treatment is cessation of the inciting stimulus, monitoring, and symptomatic management. Glycopyrrolate and atropine are common treatments for severe, intractable cases of the trigeminocardiac reflex. The trigeminocardiac reflex, while underreported and underrepresented in dermatologic literature and dermatologic surgery settings, should be considered in the setting of bradycardia and hypotension during dermatologic procedures.
Sections du résumé
BACKGROUND
The trigeminocardiac reflex is a common but underreported occurrence that can vary from benign to life threatening. This reflex can be elicited by placing direct pressure on the globe of the eye or from traction of the extraocular muscles, stimulating the trigeminal nerve.
OBJECTIVE
To provide a review of potential stimuli for the trigeminocardiac reflex within dermatologic surgery and to discuss management options for the treatment of the trigeminocardiac reflex.
METHODS
PubMed and Cochrane were used to identify articles and case reports that established scenarios in which the trigeminocardiac reflex was provoked and subsequently how the reflex was managed.
RESULTS
Within the field of dermatologic surgery, the trigeminocardiac reflex can be stimulated during biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions, most often occurring in an office setting. The most common presentations include significant bradycardia, hypotension, gastric hypermobility, and lightheadedness. The most definitive treatment is cessation of the inciting stimulus, monitoring, and symptomatic management. Glycopyrrolate and atropine are common treatments for severe, intractable cases of the trigeminocardiac reflex.
CONCLUSION
The trigeminocardiac reflex, while underreported and underrepresented in dermatologic literature and dermatologic surgery settings, should be considered in the setting of bradycardia and hypotension during dermatologic procedures.
Identifiants
pubmed: 37134251
doi: 10.1097/DSS.0000000000003808
pii: 00042728-202307000-00005
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
654-658Informations de copyright
Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Engel D. The gastroauricular phenomenon and related vagus reflexes. Archiv Psychiatrie Nervenkr 1979;227:271–7.
Dunville LM, Kramer J. Oculocardiac reflex. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. Available at: http://www.ncbi.nlm.nih.gov/books/NBK499832/ . Accessed November 13, 2019.
Joshi UM, Munnangi A, Shah K, Patil SG, Thakur N. Trigemino-cardiac reflex: a phenomenon neglected in maxillofacial surgery? J Maxillofac Oral Surg 2017;16:181–5.
Kumada M, Dampney RAL, Reis DJ. The trigeminal depressor response: a cardiovascular reflex originating from the trigeminal system. Brain Res 1975;92:485–9.
Shelly MP, Church JJ. Bradycardia and facial surgery. Anaesthesia 1988;43:422.
Lang S, Lanigan DT, van der Wal M. Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. Can J Anaesth 1991;38:757–60.
Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 1999;90:215–20.
Barnard NA, Bainton R. Bradycardia and the trigeminal nerve. J Craniomaxillofac Surg 1990;18:359–60.
Meuwly C, Chowdhury T, Sandu N, Golanov E, et al. Definition and diagnosis of the trigeminocardiac reflex: a grounded theory approach for an update. Front Neurol 2017;8:533.
Bloom JN. Oculocardiac reflex. Br J Ophthalmol 1981;65:589–90.
Chowdhury T, Mendelowith D, Golanov E, Spiriev T, et al. Trigeminocardiac reflex: the current clinical and physiological knowledge. J Neurosurg Anesthesiol 2015;27:136–47.
Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol 2019;19:36.
Chung SY, Langer PD. Pediatric orbital blowout fractures. Curr Opin Ophthalmol 2017;28:470–6.
Ducloyer J-B, Couret C, Magne C, Lejus-Bourdeau C, et al. Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery. Eur J Ophthalmol 2019;29:606–14.
Hayes RW, McBrearty E. An oculo-cardiac hypothesis of sudden unexpected death in infants. Med Hypotheses 1979;5:477–80.
Kim S-H, Shin HJ. Effects of an infratrochlear nerve block on reducing the oculocardiac reflex during strabismus surgery: a randomized controlled trial. Graefe's Archive Clin Exp Ophthalmol 2018;256:1777–82.
Prabhakar H, Arasho B, Sandu N, Spiriev T, Schaller B. Management of the trigeminocardiac reflex: facts and own experience. Neurol India 2009;57:375–80.
Van Brocklin MD, Hirons RR, Yolton RL. The oculocardiac reflex: a review. J Am Optom Assoc 1982;53:407–13.
Mirakhur RK, Shepherd WFI, Jones CJ. Ventilation and the oculocardiac reflex. Anaesthesia 1986;41:825–8.
Guedes AA, Pereira FL, Machado EG, Salgado Filho MF, et al. [Delayed trigeminocardiac reflex after maxillofacial surgery: case report]. Braz J Anesthesiol 2019;69:315–8.
Leon-Ariza DS, Leon-Ariza JS, Nangiana J, Vargas Grau G, et al. Evidences in neurological surgery and a cutting edge classification of the trigeminocardiac reflex: a systematic review. World Neurosurg 2018;117:4–10.
Neils DM, Singanallur PS, Vasilakis M, Wang H, et al. Incidence and ramifications of the oculocardiac reflex during the orbitozygomatic approach: a prospective assessment. World Neurosurg 2014;82:e765–769.
Meuwly C, Chowdhury T, Sandu N, Schaller BJ. Meta-areas of the trigeminocardiac reflex within the skull base: a neuroanatomic “thinking” model. J Neurosurg Anesthesiol 2016;28:437–8.
Fahling JM, McKenzie LK. Oculocardiac reflex as a result of intraorbital trauma. J Emerg Med 2017;52:557–8.
Pham CM, Couch SM. Oculocardiac reflex elicited by orbital floor fracture and inferior globe displacement. Am J Ophthalmol Case Rep 2017;6:4–6.
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.
Tamura T, Rex DE, Marosfoi MG, Puri AS, et al. Republished: trigeminocardiac reflex caused by selective angiography of the middle meningeal artery. Journal of Neurointerv Surg. 2017;9:e10.
Kiani MT, Tajik G, Ajami M, Fazli H, et al. Trigeminocardiac reflex and haemodynamic changes during Le Fort I osteotomy. Int J Oral Maxillofac Surg 2016;45:567–70.
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;15:203–9.
Karaman T, Demir S, Dogru S, Şahin A, et al. The effect of anesthesia depth on the oculocardiac reflex in strabismus surgery. J Clin Monit Comput 2016;30:889–93.
Schaller B, Cornelius JF, Prabhakar H, Koerbel A, et al. The trigemino-cardiac reflex: an update of the current knowledge. J Neurosurg Anesthesiol 2009;21:187–95.
Yorgancilar E, Gun R, Yildirim M, Bakir S, et al. Determination of trigeminocardiac reflex during rhinoplasty. Int J Oral Maxillofac Surg 2012;41:389–93.
Özçelik D, Toplu G, Türkseven A, Sezen G, Ankarali H. The importance of the trigeminal cardiac reflex in rhinoplasty surgery. Ann Plast Surg 2015;75:213–8.
Buchholz B, Kelly J, Bernatene EA, Méndez Diodati N, Gelpi RJ. Antagonistic and synergistic activation of cardiovascular vagal and sympathetic motor outflows in trigeminal reflexes. Front Neurol 2017;8:52.
Kumada M, Dampney RA, Whitnall MH, Reis DJ. Hemodynamic similarities between the trigeminal and aortic vasodepressor responses. Am J Physiol 1978;234:H67–73.
Alboni P, Alboni M, Gianfranchi L. Diving bradycardia: a mechanism of defence against hypoxic damage. J Cardiovasc Med 2011;12:422–7.
Foster GE, Sheel AW. The human diving response, its function, and its control. Scand J Med Sci Sports 2005;15:3–12.
Cavallo LM, Solari D, Esposito F. Trigeminocardiac reflex: a predictable event with unpredictable aspects. World Neurosurg 2011;76:407–8.
Moonie GT, Rees DL, Elton D. The oculocardiag reflex during strabismus surgery. Can Anaesthetists’ Soc J 1964;11:621–32.
Singh GP, Chowdhury T, Bindu B, Schaller B. Sudden infant death syndrome – role of trigeminocardiac reflex: a review. Front Neurol 2016;7:221.
Abdulazim A, Stienen MN, Sadr-Eshkevari P, et al. Trigeminocardiac reflex in neurosurgery–current knowledge and prospects. Explic Cases Controv Issues Neurosurg 2012;5–13.
Bohluli B, Ashtiani AK, Khayampoor A, Sadr-Eshkevari P. Trigeminocardiac reflex: a MaxFax literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:184–8.
Song I-A, Seo K-S, Oh A-Y, Baik JS, et al. Dexmedetomidine injection during strabismus surgery reduces emergence agitation without increasing the oculocardiac reflex in children: a randomized controlled trial. PLoS One 2016;11:e0162785.
Arnold RW, Jensen PA, Kovtoun TA, Maurer SA, Schultz J-A. The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q 2004;19:215–22.
Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand 2008;52:1273–7.
Alexander JP. Reflex disturbances of cardiac rhythm during ophthalmic surgery. Br J Ophthalmol 1975;59:518–24.
Dewar KM, Wishart HY. The oculocardiac reflex. Proc R Soc Med 1976;69:373–4.
Khurana RK, Wu R. The cold face test: a non-baroreflex mediated test of cardiac vagal function. Clin Auton Res 2006;16:202–7.
James JE, Daly MdB. Reflex respiratory and cardiovascular effects of stimulation of receptors in the nose of the dog. J Physiol 1972;220:673–96.
Yu YH, Blessing WW. Cerebral blood flow in rabbits during the nasopharyngeal reflex elicited by inhalation of noxious vapor. J Auton Nervous Syst 1997;66:149–53.
Schipke JD, Siegmund K, Taher A, Krüll M, et al. Loss of consciousness via oculocardiac reflex during deep breath-hold diving. A case report. Int J Cardiol 2015;193:56–7.
Chowdhury T, Meuwly C, Sandu N, Cappellani RB, Schaller B. Coronary spasm in neurosurgical patients and role of trigeminocardiac reflex. Neurol Res Int 2014;2014:1–5.
Chowdhury T, Sandu N, Schaller B, Meuwly C. Peripheral trigeminocardiac reflex. Am J Otolaryngol 2013;34:616.
Spiriev T, Sandu N, Kondoff S, Tzekov C, Schaller B. Letter to the editor: tic and autonomic symptoms. J Neurosurg 2012;116:1397–8.
Chowdhury T, Cappellani RB, Schaller B. Chronic trigemino-cardiac reflex in patient with orbital floor fracture: role of surgery and first description. J Neurosurg Anesthesiol 2014;26:91–2.
Bloch M. Oculocardiac reflex: “My heart just stopped”. Emerg Med Australas 2018;30:592–3.
Seker A, Toktas ZO, Peker S, Batirel HA, Necmettin Pamir M. Asystole due to trigemino-cardiac reflex: a rare complication of trans-sphenoidal surgery for pituitary adenoma. J Clin Neurosci 2009;16:338–40.
Meuwly C, Chowdhury T, Sandu N, Reck M, et al. Anesthetic influence on occurrence and treatment of the trigemino-cardiac reflex. Medicine (Baltimore) 2015;94:e807.
Wang X, Gorini C, Sharp D, Bateman R, Mendelowitz D. Anaesthetics differentially modulate the trigeminocardiac reflex excitatory synaptic pathway in the brainstem. J Physiol 2011;589:5431–42.
Arnold RW, Biggs RE, Beerle BJ. Intravenous dexmedetomidine augments the oculocardiac reflex. J AAPOS 2018;22:211–3.e1.
Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, et al. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran 2015;53:158–61.
Chigurupati K, Vemuri NN, Velivela SR, Mastan SS, Thotakura AK. Topical lidocaine to suppress trigemino-cardiac reflex. Br J Anaesth 2013;110:145.