Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11967-11973
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11967
Repeated ventricular bigeminy by trigeminocardiac reflex despite atropine administration during superficial upper lip surgery: A case report
Su-Yeon Cho, Bo-Hyun Jang, Hye-Jin Jeon, Dong-Joon Kim
Su-Yeon Cho, Bo-Hyun Jang, Hye-Jin Jeon, Dong-Joon Kim, Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
Author contributions: Cho SY conceived the article; Cho SY and Jang BH collected the data; Jeon HJ assembled the data; Cho SY, Jang BH, Jeon HJ, Kim DJ provided the study materials, write the manuscript and approved the manuscript.
Supported by Chosun University Hospital, 2018.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Joon Kim, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Pilmun-daero 365, Gwangju 61453, South Korea. djkim@chosun.ac.kr
Received: August 2, 2022
Peer-review started: August 2, 2022
First decision: September 5, 2022
Revised: September 15, 2022
Accepted: October 18, 2022
Article in press: October 18, 2022
Published online: November 16, 2022
Processing time: 97 Days and 8.3 Hours
Abstract
BACKGROUND

The trigeminocardiac reflex (TCR) is usually caused by an increased parasympathetic tone when pressure or traction is applied to the surrounding tissue of the trigeminal nerve. However, the inexperienced anesthesiologists may have challenges on the management of TCR patients.

CASE SUMMARY

This is the case of an 18-year-old woman diagnosed with hemangioma of the upper lip. During the operation, about 1 h after surgery started, a constant 1:1 premature ventricular complex was detected, and blood pressure was decreased when approaching the deeper part with more strong traction for exposure of the part. Although the management of arrhythmias, such as lidocaine and atropine, was injected, arrhythmia induced by surgical stimulation could not be eliminated completely. As the traction repeated, bradycardia was also repeated, despite injecting additional atropine. Therefore, the anesthesiologist and the surgeon decided to perform the operation only to the extent that the vascular tissue was selectively removed only at the site without the reflex.

CONCLUSION

With TCR, anesthesiologists should perform appropriate monitoring. In addition to proper drug administration, surgeons should be consulted to cope with stopping the surgery and setting the scope of the surgery even if the site is superficial.

Keywords: Trigeminocardiac reflex; Bigeminy; Arrhythmia; Hypotension; Atropine; Case report

Core Tip: The trigeminocardiac reflex (TCR) occurs when stimulation occurs adjacent to the trigeminal nerve. TCR usually results from stimulation of the central region of the trigeminal nerve and can result in lowered blood pressure and heart rate. Mild symptoms can be overcome with anticholinergic drugs such as atropine. But in this case, it is challenging to expect due to peripheral stimulation. And the bradycardia repeatedly occurred after the drug action time passed. In the end, it is crucial to quickly prevent complications by the reflex with proper monitoring and management.