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Bernhard Schaller - One of the best experts on this subject based on the ideXlab platform.
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a step further the role of Trigeminocardiac Reflex in therapeutic implications hypothesis evidence and experimental models
2021Co-Authors: Tumul Chowdhury, Eugene V Golanov, Frederic Lemaitre, Kristel L A M Kuypers, Bruno Buchholz, Ricardo J Gelpi, Bernhard SchallerAbstract:The Trigeminocardiac Reflex (TCR) is a well-recognized brainstem Reflex that represents a unique interaction between the brain and the heart through the Vth and Xth cranial nerves and brainstem nuclei. The TCR has mainly been reported as an intraoperative phenomenon causing cardiovascular changes during skull-base surgeries. However, it is now appreciated that the TCR is implicated during non-neurosurgical procedures and in nonsurgical conditions, and its complex Reflex pathways have been explored as potential therapeutic options in various neurological and cardiovascular diseases. This narrative review presents an in-depth overview of hypothetical and experimental models of the TCR phenomenon in relation to the Vth and Xth cranial nerves. In addition, primitive interactions between these 2 cranial nerves and their significance are highlighted. Finally, therapeutic models of the complex interactions of the TCR and areas for further research will be considered.
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brain and heart crosstalk during neurointerventional procedures the role of the Trigeminocardiac Reflex an updated systematic review
2020Co-Authors: Tumul Chowdhury, Abanoub Aziz Rizk, Emad Al Azazi, Lashmi Venkatraghavan, Jai S Shankar, Bernhard SchallerAbstract:The Trigeminocardiac Reflex is a well-described brainstem Reflex that clinically manifests as bradycardia, hypotension, or apnea. This physiological phenomenon is extensively reported during open neurosurgical procedures, but very few data exist for Trigeminocardiac Reflex occurrence during neurointerventional procedures. This systematic review aims to provide aggregated information related to the Trigeminocardiac Reflex during neurointerventional procedures and to improve understanding of the various mechanisms that can incite this unique brain-heart crosstalk.
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sinus arrest with prolonged asystole due to the Trigeminocardiac Reflex during application of local anaesthetic in the nasal mucosa
2018Co-Authors: Cyrill Meuwly, Gregor Leibundgut, Thomas Rosemann, Bernhard SchallerAbstract:The Trigeminocardiac Reflex (TCR) is defined as a sudden onset of parasympathetic dysrhythmias during stimulation of the trigeminal nerve. We describe a peripheral variation of TCR during manipulation of the nasal mucosa. A 42-year-old patient suffering from severe obstructive sleep apnoea was scheduled for surgical treatment. After inducted anaesthesia, the surgeon infiltrated the nasal mucosa with a local anaesthetic. The patient immediately showed an asystole and was treated with ephedrine and five chest compressions, despite spontaneous sinus rhythm return after ceasing of manipulation. Treatment with atropine established this TCR episode and ensured an event-free surgery.The authors present here, for the first time, a prolonged asystole caused by the TCR, triggered by minimal manipulation of the nasal mucosa. This severe manifestation of peripheral TCR demonstrates its importance in daily clinical business. This case was treated according to a modified treatment algorithm for all subtypes of TCR which is presented here.
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Trigeminocardiac Reflex: an overview
2018Co-Authors: Tumul Chowshury, Thomas Rosemann, Bernhard SchallerAbstract:Trigemino-cardiac Reflex is a unique brain stem Reflex that manifests as negative cardio-respiratory perturbations. This Reflex is largely reported in skull base surgeries/interventions; however, in the recent time, it is also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This Reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Therefore, this narrative review intends to elaborate its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.
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definition and diagnosis of the Trigeminocardiac Reflex a grounded theory approach for an update
2017Co-Authors: Cyrill Meuwly, Nora Sandu, Thomas Rosemann, Tumul Chowdhury, Paul Erne, Eugene V Golanov, Bernhard SchallerAbstract: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. Conclusions 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.
Nora Sandu - One of the best experts on this subject based on the ideXlab platform.
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definition and diagnosis of the Trigeminocardiac Reflex a grounded theory approach for an update
2017Co-Authors: Cyrill Meuwly, Nora Sandu, Thomas Rosemann, Tumul Chowdhury, Paul Erne, Eugene V Golanov, Bernhard SchallerAbstract: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. Conclusions 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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how to apply case reports in clinical practice using surrogate models via example of the Trigeminocardiac Reflex
2016Co-Authors: Nora Sandu, Tumul Chowdhury, Bernhard SchallerAbstract: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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functional outcome changes in surgery for pituitary adenomas after intraoperative occurrence of the Trigeminocardiac Reflex first description in a retrospective observational study
2015Co-Authors: T Chowdhury, Nora Sandu, Michael Buchfelder, Christoph Nothen, Andreas K Filis, Bernhard SchallerAbstract: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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Trigeminocardiac Reflex the current clinical and physiological knowledge
2015Co-Authors: Tumul Chowdhury, Toma Spiriev, Nora Sandu, Cyrill Meuwly, Pooyan Sadreshkevari, Belachew Arasho, David Mendelowith, Eugene V Golanov, Bernhard SchallerAbstract:The Trigeminocardiac Reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem Reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. There is also a growing need to discuss its cellular mechanism and functional consequences. Therefore, the current review provides an updated examination of the TCR with a particular focus on the mechanisms and diverse nature of the TCR.
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Trigeminocardiac Reflex definition and introduction
2015Co-Authors: Cyrill Meuwly, Nora Sandu, Tumul Chowdhury, Paul Erne, Bernhard SchallerAbstract:The Trigeminocardiac Reflex (TCR) is nowadays a well-established brain stem phenomenon in skull-base surgery and related disciplines. Because the study of the TCR is a rapidly growing field, new knowledge is constantly being created, mostly from single cases or a small series of cases. It is therefore time to incorporate all this knowledge into the definition of the phenomenon, expand the definition, and integrate it into physiological knowledge about the involved cranial nerves and the autonomous system. We therefore present here, for the first time, an overview of the definition of the TCR, based on clinical knowledge and related methodological considerations, as well as on neurophysiology and neuroanatomy. In this chapter, ambiguities are clarified and a window is opened for further discussion of definitions of this Reflex.
Tumul Chowdhury - One of the best experts on this subject based on the ideXlab platform.
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a step further the role of Trigeminocardiac Reflex in therapeutic implications hypothesis evidence and experimental models
2021Co-Authors: Tumul Chowdhury, Eugene V Golanov, Frederic Lemaitre, Kristel L A M Kuypers, Bruno Buchholz, Ricardo J Gelpi, Bernhard SchallerAbstract:The Trigeminocardiac Reflex (TCR) is a well-recognized brainstem Reflex that represents a unique interaction between the brain and the heart through the Vth and Xth cranial nerves and brainstem nuclei. The TCR has mainly been reported as an intraoperative phenomenon causing cardiovascular changes during skull-base surgeries. However, it is now appreciated that the TCR is implicated during non-neurosurgical procedures and in nonsurgical conditions, and its complex Reflex pathways have been explored as potential therapeutic options in various neurological and cardiovascular diseases. This narrative review presents an in-depth overview of hypothetical and experimental models of the TCR phenomenon in relation to the Vth and Xth cranial nerves. In addition, primitive interactions between these 2 cranial nerves and their significance are highlighted. Finally, therapeutic models of the complex interactions of the TCR and areas for further research will be considered.
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brain and heart crosstalk during neurointerventional procedures the role of the Trigeminocardiac Reflex an updated systematic review
2020Co-Authors: Tumul Chowdhury, Abanoub Aziz Rizk, Emad Al Azazi, Lashmi Venkatraghavan, Jai S Shankar, Bernhard SchallerAbstract:The Trigeminocardiac Reflex is a well-described brainstem Reflex that clinically manifests as bradycardia, hypotension, or apnea. This physiological phenomenon is extensively reported during open neurosurgical procedures, but very few data exist for Trigeminocardiac Reflex occurrence during neurointerventional procedures. This systematic review aims to provide aggregated information related to the Trigeminocardiac Reflex during neurointerventional procedures and to improve understanding of the various mechanisms that can incite this unique brain-heart crosstalk.
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definition and diagnosis of the Trigeminocardiac Reflex a grounded theory approach for an update
2017Co-Authors: Cyrill Meuwly, Nora Sandu, Thomas Rosemann, Tumul Chowdhury, Paul Erne, Eugene V Golanov, Bernhard SchallerAbstract: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. Conclusions 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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rhinitis and sleep disorders the Trigeminocardiac Reflex link
2017Co-Authors: Barkha Bindu, Gyaninder Pal Singh, Tumul Chowdhury, Bernhard SchallerAbstract:Rhinitis, allergic or non-allergic, is an inflammatory condition of the nose. It is associated with a wide range of sleep disorders that are generally attributed to nasal congestion and presence of inflammatory mediators like cytokines and interleukins. However, the pathophysiological mechanisms behind these sleep disorders remain unclear. On the other hand, the Trigeminocardiac Reflex (TCR) has recently been linked to various sleep disorders like obstructive sleep apnea, sleep bruxism and rapid eye movement (REM) sleep apnea. TCR can be incited by stimulation of the trigeminal nerve or the area innervated by its branches including the nasal mucosa. Trigeminal nasal afferents can be activated on exposure to noxious stimuli (mechanical or chemical) like ammonia vapors, carbon-dioxide, nicotine, hypertonic saline, air-puffs and smoke. In rhinitis, there is associated neuronal hyper-responsiveness of sensory nasal afferents due to inflammation (which can be suppressed by steroids). This may further lead to increased occurrence of TCR in rhinitis. Moreover, there is involvement of autonomic nervous system both in rhinitis and TCR. In TCR, parasympathetic over activity and sympathetic inhibition leads to sudden onset bradycardia, hypotension, apnea and gastric motility. Also, the autonomic imbalance reportedly plays a significant role in the pathophysiology of rhinitis. Thus, considering these facts we hypothesize that the TCR could be the link between rhinitis and sleep disorders and we believe that further research in this direction may yield significant development in our understanding of sleep disorders in rhinitis.
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Brain and heart connections: The Trigeminocardiac Reflex!
2017Co-Authors: Gyaninder P Singh, Tumul ChowdhuryAbstract:Trigeminocardiac Reflex (TCR) is a well-established neurogenic Reflex although its exact mechanism and clinical significance remain unclear. This Reflex may be incited by stimulation of the trigeminal nerve anywhere along its course starting from the peripheral distribution to the central nucleus. It usually manifests as bradycardia, asystole, hypotension, apnoea and gastric hypermotility; though other clinical manifestation such as tachycardia and hypertension may also occur. Diving Reflex (DR) shares many similarities with TCR in both clinical manifestation and mechanism of action and is often considered as a modified or subtype of TCR. DR is an important physiological adaptation to withstand hypoxiaduring apnoea in many animal species including humans and thus belongs to a group of oxygen-conserving Reflexes. Although TCR is a physiological Reflex having protective function, an exaggerated response may have fatal consequences. Surgeries or stimulation involving head, neck and face region (area supplied by trigeminal nerve) are particularly prone to provoke this Reflex. Vigilant and continuous monitoring for early identification of warning signs and communication with surgeon to interrupt the stimulus immediately is enough to cease the Reflex in most of the cases. However, failure to identify and treat in time may have deleterious consequences and thus TCR has gained much attention and awareness in recent years. Over the last two decades, our knowledge on TCR has expanded but we still remain far from complete elucidation of pathophysiology, mechanism and clinical significance of this unique 'brain and heart connection' called TCR
Michael Buchfelder - One of the best experts on this subject based on the ideXlab platform.
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functional outcome changes in surgery for pituitary adenomas after intraoperative occurrence of the Trigeminocardiac Reflex first description in a retrospective observational study
2015Co-Authors: T Chowdhury, Nora Sandu, Michael Buchfelder, Christoph Nothen, Andreas K Filis, Bernhard SchallerAbstract: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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Trigeminocardiac Reflex in embolization of intracranial dural arteriovenous fistula
2008Co-Authors: Bernhard Schaller, A Filis, Michael BuchfelderAbstract:We have read with great interest the article of Lv et al[1][1] about the immediate reproducible and Reflexive response of the Trigeminocardiac Reflex (TCR) stimulation by Onyx (ev3, Irvine, Calif) injection during embolization of a tentorial dural arteriovenous fistula in a 53-year-old man. We are
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transient asystole during endoscopic transsphenoidal surgery an example of Trigeminocardiac Reflex
2008Co-Authors: Bernhard Schaller, Nora Sandu, Andreas Filis, Giulia Ottoviani, Christoph Noethen, Michael BuchfelderAbstract:Dear Sir We have read with great interest the case report of AbouZeid et al. [1] demonstrating a Trigeminocardiac Reflex (TCR) after transsphenoidal surgery in the wall of the cavernous sinus. It underlines our previous findings that a central Reflex-triggering is only possible during transsphenoidal surgery by manipulation in the cavernous sinus [2–4]. However, there is strong evidence for our hypothesis that the TCR triggered by peripheral stimulation (via spinal nucleus of trigeminal nerve to the Kolliker-Fuse nucleus) is different from the TCR triggered by central stimulation (via nucleus of solitary tract to the lateral parabrachial nucleus) [2, 5]. The peripheral TCR plays a key role in the diving response of mammals which is induced by face immersion. The diving Reflex, elicited in mammals by contact of the fact with cold water, consists of breath holding, intense peripheral vasoconstriction, bradycardia, decreased ventilation and increased mean arterial pressure, with the purpose to prevent drowing and to provide an oxygen reservoir in the lungs, heart and brain [6]. The diving Reflex is physiologically programmed to maintain life under conditions of danger but, if pathological, is frequently considered in the pathogenesis of sudden infant death syndrome (SIDS) [7–9]. The main risk factor for intraoperative TCR may be a hyperactive diving Reflex underlying our data that demonstrate that TCR is a refractory to conventional management in adults [5]. This hypothesis may be underlined by the finding of Prabhakar et al. [10] who described the occurrence of a TCR in the inital and also in the re-operation of a tumor in the cerebellopontine angle. It is most likely that even minimal alterations or stimulations along neuronal pathways of the Reflex arches interfere with the triggering and/or the Reflex response and thus could transform a (para)physiological action into a lethal event. Cardiac or cardiorespiratory arrest could happen whenever lesions are located in the central or peripheral neuronal centers and in the most delicate and complex brainstem neuronal circuitry [7, 8]. In conclusion, the partly different Reflex arches for peripheral -and central induced-TCR may also explain why the peripheral-induced TCR is seen so seldom in transsphenoidal surgery compared with the centralinduced TCR one [11]. Further studies on triggering factors and related mechanisms are needed to gain a better understanding of the complex interactions involved in the TCR in case of sudden death after diving or other trigeminal stimulation. Precise examinations of the brainstem on serial sections [7–9] are crucial to the identification of the morphological substrates responsible for these Reflexes. B. Schaller (&) N. Sandu Departments of Neurosurgery, University of Paris, Paris, France e-mail: skull_base_surgery@yahoo.de
James Isheng Huang - One of the best experts on this subject based on the ideXlab platform.
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Trigeminocardiac Reflex during non-surgical root canal treatment of teeth with irreversible pulpitis
2018Co-Authors: James Isheng Huang, Hao-hueng Chang, Chun-pei Lin, Wan-chuen Liao, Chia-tze Kao, Tsui-hsien HuangAbstract:Background/Purpose: Trigeminocardiac Reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR. Methods: This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. Results: The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values
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occurrence of Trigeminocardiac Reflex during dental implant surgery an observational prospective study
2017Co-Authors: James Isheng Huang, Yuchao ChangAbstract:Background/Purpose Trigeminocardiac Reflex (TCR) is a clinical phenomenon that manifests as s sudden onset of hemodynamic perturbations. TCR has been reported in cranio-maxillofacial surgery resulting in severe medical risks. Monitoring the hemodynamic changes during cranio-maxillofacial surgery can provide important information to ensure the continuous evaluation of patient's physical conditions. This prospective observational study was conducted to determine the hemodynamic alterations related to the possibly of occurrence of TCR in patients during dental implant surgery. Methods One hundred and thirty-five patients (69 males and 66 females) received dental implant placement were enrolled in this study. The hemodynamic changes were evaluated by monitoring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oximetry (SpO2). The above data were collected before, during, and after dental implant surgery. Results The data demonstrated that the minimal values of HR, SBP, and DBP as well as MABP decreased significantly during operation comparing with the corresponding values before operation (p Conclusion A significant HR and BP reduction possibly due to TCR can occur during dental implant surgery. Therefore, the dentists should monitor the hemodynamic changes during dental implant surgery to prevent the possible occurrence of medical risks related to TCR.
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Trigeminocardiac Reflex during non surgical root canal treatment of teeth with irreversible pulpitis
2017Co-Authors: James Isheng Huang, Hao-hueng Chang, Chun-pei Lin, Wan-chuen Liao, Chia-tze Kao, Tsui-hsien HuangAbstract:Background/Purpose Trigeminocardiac Reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR. Methods This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. Results The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values Conclusion We conclude that vital pulp extirpation may lead to a substantial drop in patient's blood pressure possibly related to TCR.
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Occurrence of Trigeminocardiac Reflex during dental implant surgery: An observational prospective study
2017Co-Authors: James Isheng Huang, Yuchao ChangAbstract:Trigeminocardiac Reflex (TCR) is a clinical phenomenon that manifests as s sudden onset of hemodynamic perturbations. TCR has been reported in cranio-maxillofacial surgery resulting in severe medical risks. Monitoring the hemodynamic changes during cranio-maxillofacial surgery can provide important information to ensure the continuous evaluation of patient's physical conditions. This prospective observational study was conducted to determine the hemodynamic alterations related to the possibly of occurrence of TCR in patients during dental implant surgery. Methods: One hundred and thirty-five patients (69 males and 66 females) received dental implant placement were enrolled in this study. The hemodynamic changes were evaluated by monitoring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oximetry (SpO2). The above data were collected before, during, and after dental implant surgery. Results: The data demonstrated that the minimal values of HR, SBP, and DBP as well as MABP decreased significantly during operation comparing with the corresponding values before operation (p
