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Journal of Maxillofacial and Oral... Dec 2014The purpose of this paper was to undertake a review of literature on trigeminocardiac reflex in oral and maxillofacial online data-base and discuss the pathophysiology,... (Review)
Review
PURPOSE
The purpose of this paper was to undertake a review of literature on trigeminocardiac reflex in oral and maxillofacial online data-base and discuss the pathophysiology, risk factor assessment, presentation of the reflex, prevention, management with emphasis on the role of the attending anaesthetist and the maxillofacial surgeon.
MATERIALS AND METHODS
The available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review published clinical papers, abstracts and evidence based reviews on trigeminocardiac reflex relevant to oral and maxillofacial surgery.
RESULTS
Sixty-five articles were found with the search term "trigeminocardiac reflex" in the literature searched. Eighteen articles met the inclusion criteria for this study. The relevant data was extracted, tabulated and reviewed to draw evidence based conclusions for the management of trigeminocardiac reflex.
CONCLUSIONS
Conclusions were drawn and discussed based on the reviewed maxillofacial literature with emphasis on the anaesthetist's and the surgeon's role in the management of this detrimental event in maxillofacial surgical practice.
PubMed: 26224999
DOI: 10.1007/s12663-013-0541-4 -
Health Psychology Review Jun 2023Smiling has been a topic of interest to psychologists for decades, with a myriad of studies tying this behavior to well-being. Despite this, we know surprisingly little... (Review)
Review
Smiling has been a topic of interest to psychologists for decades, with a myriad of studies tying this behavior to well-being. Despite this, we know surprisingly little about the nature of the connections between smiling and physical health. We review the literature connecting both naturally occurring smiles and experimentally manipulated smiles to physical health and health-relevant outcomes. This work is discussed in the context of existing affect and health-relevant theoretical models that help explain the connection between smiling and physical health including the facial feedback hypothesis, the undoing hypothesis, the generalized unsafety theory of stress, and polyvagal theory. We also describe a number of plausible pathways, some new and relatively untested, through which smiling may influence physical health such as trait or state positive affect, social relationships, stress buffering, and the oculocardiac reflex. Finally, we provide a discussion of possible future directions, including the importance of cultural variation and replication. Although this field is still in its infancy, the findings from both naturally occurring smile studies and experimentally manipulated smile studies consistently suggest that smiling may have a number of health-relevant benefits including beneficially impacting our physiology during acute stress, improved stress recovery, and reduced illness over time.
Topics: Humans; Smiling; Facial Expression; Interpersonal Relations; Face; Feedback
PubMed: 35285408
DOI: 10.1080/17437199.2022.2052740 -
BMC Anesthesiology Mar 2019The oculocardiac reflex (OCR), bradycardia that occurs during strabismus surgery is a type of trigemino-cardiac reflex (TCR) is blocked by anticholinergics and enhanced...
BACKGROUND
The oculocardiac reflex (OCR), bradycardia that occurs during strabismus surgery is a type of trigemino-cardiac reflex (TCR) is blocked by anticholinergics and enhanced by opioids and dexmedetomidine. Two recent studies suggest that deeper inhalational anesthesia monitored by BIS protects against OCR; we wondered if our data correlated similarly.
METHODS
In an ongoing, prospective study of OCR/TCR elicited by 10-s, 200 g square-wave traction on extraocular muscles (EOM) from 2009 to 2013, anesthetic depth was estimated in cohorts using either BIS or Narcotrend monitors. The depth of anesthesia was deliberately varied between first and second EOM tested.
RESULTS
From 1992 through 2013, 2833 cases of OCR during strabismus surgery were monitored. Excluding re-operations and cases with anticholinergic, OCR from first EOM traction averaged - 20.2 ± 21.8% (S.D.) with a range from - 95 to + 25% in patients aged 0.2 to 90 (median 6.5) years. We did not find correlation between %OCR and brain wave for 97 patients with BIS monitoring and 91 with Narcotrend. With intra-patient controls between first and second muscle, the difference in brain wave did not correlate with difference in %OCR for BIS (r = 0.0002, 95% C. I -0.0002, 0.002, p = 0.30) or for Narcotrend (r = - 0.001, 95% C. I -0.004, 0.001, p = 0.32). Secondary multi-variable analysis demonstrated significant association on %OCR particularly with BIS monitor, opioid, propofol and nitrous oxide concentration in the second EOM tensioned. Sevoflurane concentration correlated better with BIS monitor in second and third EOM tension. %OCR correlated with younger age (p < 0.01). OCR with rapid onset was more profound than those with gradual onset (difference in means 18, 95% C. I 10, 26%).
CONCLUSIONS
We were unable to confirm a direct correlation between brain wave monitor and OCR when using multifactorial anesthetic agents. The discrepency with other studies probably reflects direct impact of inhalational agent concentration and less deliberate quantification of EOM tension. We found no level of BIS or Entropy EEG monitoring that uniformly prevents OCR.
TRIAL REGISTRY
NCT03663413.
DATA
http://www.abcd-vision.org/OCR/OCR%20Brainwave%20de-identified.pdf .
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Inhalation; Bradycardia; Brain Waves; Child; Child, Preschool; Consciousness Monitors; Female; Humans; Infant; Male; Middle Aged; Oculomotor Muscles; Prospective Studies; Reflex, Oculocardiac; Sevoflurane; Strabismus; Young Adult
PubMed: 30871507
DOI: 10.1186/s12871-019-0712-z -
SAGE Open Medical Case Reports 2022Oculocardiac reflex is a phenomenon caused by traction applied to the extraocular muscles, or pressure on the globes. The afferent stimulus travels via the ophthalmic...
Oculocardiac reflex is a phenomenon caused by traction applied to the extraocular muscles, or pressure on the globes. The afferent stimulus travels via the ophthalmic branch of cranial nerve V, and the efferent stimulus travels via cranial nerve X, which can cause severe bradycardia and potentially hypotension, atrioventricular block, ventricular ectopy, and rarely asystole. Oculocardiac reflex is different from vasovagal syncope which has another pathway, and is triggered by pain or emotional upset, that results in failure of autoregulation of blood pressure. Ophthalmologists often observe oculocardiac reflex intraoperatively upon manipulation of extraocular muscles during strabismus surgeries. We report a case with a previously undescribed complication following pterygium autograft with fibrin glue stimulating oculocardiac reflex resulting in episodes of sudden bradycardia associated with light headedness and nausea.
PubMed: 36119665
DOI: 10.1177/2050313X221122459 -
Indian Journal of Ophthalmology Apr 2021This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR.
METHODS
One hundred six patients are enrolled for phacoemulsification in a prospective and randomized study. Fifty-two patients undergo surgery in a peribulbar block (Group PB) and 54 in topical anesthesia (Group TA). Mean arterial pressure (MAP) and pulse rate are recorded during a preoperative check-up and at four other steps of surgery. Pain experienced during surgery and on a postoperative day, 5, is graded with a verbal analogue scale. OCR defined as a decrease in pulse rate by greater than 20% is calculated. Chi-square test, Fisher's exact test, paired t test and the comparison of means give the statistical analysis. A value of P < 0.05 was taken as significant.
RESULTS
MAP readings at baseline versus MAP at other steps of surgery show a trend towards rising with a P value of < 0.05 in both groups. Pulse rate measured at all steps of surgery versus baseline pulse rate in Group TA shows P < 0.05. OCR is present in nine patients in peribulbar block verses eleven patients in topical anesthesia with P value of 0.687. The pain scores using verbal analogue scale were higher in Group TA compared with Group PB with a P < 0.0001.
CONCLUSION
Oculocardiac reflex can occur during phacoemulsification under both peribulbar block and topical anesthesia, and the difference is not significant.
Topics: Administration, Topical; Anesthesia, Local; Anesthetics, Local; Humans; Lidocaine; Pain Measurement; Pain, Postoperative; Phacoemulsification; Prospective Studies; Reflex, Oculocardiac
PubMed: 33727460
DOI: 10.4103/ijo.IJO_1019_20 -
Indian Journal of Anaesthesia Feb 2020
PubMed: 32139942
DOI: 10.4103/ija.IJA_713_19 -
Acta Veterinaria Scandinavica Oct 2018The trigeminocardiac reflex (TCR) is a brainstem reflex that may be observed in anaesthesia during surgical procedures stimulating the intracranial or peripheral portion...
BACKGROUND
The trigeminocardiac reflex (TCR) is a brainstem reflex that may be observed in anaesthesia during surgical procedures stimulating the intracranial or peripheral portion of the trigeminal nerve. The peripheral TCR is divided into the oculocardiac reflex and the maxillomandibulocardiac reflex based on the affected sensory branches of the trigeminal nerve. In veterinary medicine the oculocardiac reflex has been described, however the maxillomandibulocardiac reflex has never been reported.
CASE PRESENTATION
A 5-year-old male Epagneul Breton was presented for surgical management of an upper lip mass. During surgery, a sudden severe bradycardia and a decrease in systemic arterial blood pressure developed. The occurrence of a maxillomandibulocardiac reflex was suspected on the basis of the temporary link between surgical stimulation and haemodynamic changes. Three doses of atropine were given before starting a dopamine infusion due to lack of response. The dopamine infusion normalized heart rhythm and blood pressure. The dog recovered uneventfully and he was discharged 24 h later with a sinus rhythm and no sign of recurrence of arrhythmias.
CONCLUSION
The TCR is a rare but potentially life-threatening complication of procedures involving the sensory areas innervated by the three branches of the trigeminal nerve and it may cause bradycardia with hypotension. The use of a β1-adrenergic receptor agonist such as dopamine may be indicated in cases of a refractory response to the conventional treatment with atropine.
Topics: Animals; Autonomic Dysreflexia; Diagnosis, Differential; Dog Diseases; Dogs; Intraoperative Complications; Lip Neoplasms; Male; Trigeminal Nerve
PubMed: 30373607
DOI: 10.1186/s13028-018-0421-5 -
The Journal of International Medical... Aug 2020To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2)...
Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study.
OBJECTIVE
To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration.
METHODS
The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed.
RESULTS
The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r = 0.034 and 0.058, respectively).
CONCLUSIONS
The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.
Topics: Adult; Anesthesia, General; Child; Humans; Laryngeal Masks; Reflex; Reflex, Oculocardiac; Respiration; Retrospective Studies; Strabismus
PubMed: 32787487
DOI: 10.1177/0300060520945158 -
Medicine Feb 2015Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and... (Review)
Review
Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context. Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response. The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex. In this review, we highlighted criteria for proper definition and classification of the TCR in the light of increased knowledge and present a thinking model to overcome this complexity. Further we separately discussed the role of HR and MABP and their variation in this context. As another subtopic we gave attention to is the chronic TCR; a variant that is rarely seen in clinical medicine.
Topics: Acute Disease; Bradycardia; Chronic Disease; Heart; Hemodynamics; Humans; Reflex, Trigeminocardiac; Trigeminal Nerve
PubMed: 25654391
DOI: 10.1097/MD.0000000000000484 -
Anesthesia and Analgesia May 2020Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction... (Review)
Review
Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.
Topics: Anesthesia, Conduction; Anesthetics, Local; Child; Child, Preschool; Humans; Infant; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Pediatrics
PubMed: 30676353
DOI: 10.1213/ANE.0000000000004012