Prolonged asystole induced by trigeminocardiac reflex accompanied with abnormal heart rate variability during percutaneous balloon compression: a case report
Open Access
- 17 January 2023
- journal article
- research article
- Published by SAGE Publications in Journal of International Medical Research
- Vol. 51 (1)
- https://doi.org/10.1177/03000605221148618
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.Keywords
Funding Information
- Key Research and Development Program of Hebei Province (19277714D)
This publication has 21 references indexed in Scilit:
- Trigeminal Cardiac ReflexMedicine, 2015
- The CARE Guidelines: Consensus‐Based Clinical Case Reporting Guideline DevelopmentHeadache: The Journal of Head and Face Pain, 2013
- The CARE GuidelinesDeutsches Ärzteblatt international, 2013
- Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglionActa Anaesthesiologica Taiwanica, 2012
- Propofol and arrhythmias: two sides of the coinActa Pharmacologica Sinica, 2011
- Trigeminocardiac reflex during the percutaneous injection of ethylene vinyl alcohol copolymer (Onyx) into a juvenile nasopharyngeal angiofibroma: a report of two casesJournal of NeuroInterventional Surgery, 2010
- The Trigemino-cardiac ReflexJournal of Neurosurgical Anesthesiology, 2009
- Trigemino-cardiac reflex—The trigeminal depressor responses during skull base surgeryClinical Neurology and Neurosurgery, 2008
- The profound augmentation of the oculocardiac reflex by fast acting opioids.2004
- Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflexCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1991