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Case Reports: Findings that shed new light on the possible pathogenesis of a disease
Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby
  1. Denise Bayard1,
  2. Friedrich Lersch1,
  3. Gesar Ugen1 and
  4. Bernhard Schaller2
  1. 1Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, Bern university, Bern, Switzerland
  2. 2Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
  1. Correspondence to Dr Friedrich Lersch; Friedrich.Lersch{at}insel.ch

Abstract

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.

  • Anaesthesia
  • Paediatrics
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2021-247292

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    Footnotes

    • Contributors DB was the lead author for this case report and leading the writing of the manuscript. FL was guiding the initial patient care and management, was the consultant in charge during the case, was actively involved in decision making and patient treatment, and contributed to the manuscript. GU contributed to the manuscript and its submission. BS contributed to the interpretation of the results and played a significant part in the write up of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.