Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, Hebei Province, China.
J Int Med Res. 2023 Jan;51(1):3000605221148618. doi: 10.1177/03000605221148618.
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.
三叉神经心动反射（TCR）可导致心动过缓甚至心跳骤停，消除刺激后即可逆转。在此，我们报告一例 68 岁男性在接受经皮球囊压迫治疗三叉神经痛时发生心跳骤停的病例。在该患者中，刺激消除后窦性心律未恢复，我们成功地进行了心肺复苏（CPR）。患者恢复窦性心律，并预先给予 0.5mg 阿托品，再次开始手术。手术成功完成，患者未出现并发症。随后的心率变异性（HRV）分析显示，麻醉诱导前和气管插管后迷走神经活动占主导地位。在卵圆孔穿刺时进一步升高，导致长时间的停搏。幸运的是，阿托品给药后交感神经活动占主导地位，表现为交感神经活动增加和迷走神经活动减少。这可能对 TCR 患者有益。该病例表明，TCR 相关的心跳骤停可能不会因刺激停止而逆转，阿托品在预防 TCR 中起关键作用。此外，HRV 分析对于高危患者的术前筛查可能至关重要。我们还回顾了与长时间停搏相关的 TCR 病例的文献。
