6 个月大早产儿经鼻给予右美托咪定镇静时出现非典型三叉心反射。
Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby.
机构信息
Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, Bern university, Bern, Switzerland.
Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, Bern university, Bern, Switzerland
出版信息
BMJ Case Rep. 2022 May 31;15(5):e247292. doi: 10.1136/bcr-2021-247292.
The trigeminocardiac reflex (TCR) is an established brainstem reflex leading to parasympathetic dysrhythmias-including haemodynamic irregularities, apnoea and gastric hypermotility-during stimulation of any sensory branches of the trigeminal nerve. Most of the clinical knowledge about TCR was gathered from general anaesthesia observations, not from procedural sedation.We present a case of a 6-month-old premature baby experiencing the reflex twice under dexmedetomidine-propofol-sedation while undergoing ophthalmic and ear examination. This was interpreted as cross-over sensitisation between the facial and trigeminal cranial nerve (N V and N VII).The present case demonstrates that different TCR subtypes can occur during the same anaesthetic procedure. Triggering TCR seems to be based on several factors and not just on a single stimulus as often presumed. Therefore, for premature babies, there is a risk for TCR under procedural sedation, and we recommend using glycopyrrolate as preventive treatment.
三叉心反射（TCR）是一种已确立的脑干反射，在三叉神经的任何感觉支受到刺激时，会导致副交感神经节律紊乱——包括血流动力学不规则、呼吸暂停和胃蠕动过度。关于 TCR 的大部分临床知识都是从全身麻醉观察中获得的，而不是从程序性镇静中获得的。我们报告了一例 6 个月大的早产儿在接受右美托咪定-丙泊酚镇静时，在接受眼科和耳部检查时经历了两次反射。这被解释为面部和三叉神经（N V 和 N VII）颅神经之间的交叉敏感化。本病例表明，不同的 TCR 亚型可能在同一麻醉过程中发生。触发 TCR 似乎基于多种因素，而不仅仅是如前所述的单一刺激。因此，对于早产儿来说，在程序性镇静下存在 TCR 的风险，我们建议使用硫酸阿托品作为预防治疗。
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