Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby.

Bayard, Denise; Lersch, Friedrich; Ugen, Gesar; Schaller, Bernhard (2022). Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby. BMJ case reports, 15(5) BMJ Publishing Group 10.1136/bcr-2021-247292

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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.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Bayard, Denise Sylvie, Lersch, Friedrich, Ugen, Gesar Vincent

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1757-790X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Pubmed Import

Date Deposited:

01 Jun 2022 09:12

Last Modified:

05 Dec 2022 16:20

Publisher DOI:

10.1136/bcr-2021-247292

PubMed ID:

35641083

Uncontrolled Keywords:

Anaesthesia Paediatrics Unwanted effects / adverse reactions

URI:

https://boris.unibe.ch/id/eprint/170363

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