Re: classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery.

摘要

escaped the attention of the authors. The authors classified potential risk factors for trigeminocardiac reflex (TCR) and recommended prophylactic administration of a vagolytic drug (atropine) right before any surgical manipulation known to be risky for TCR. However, a simpler alternative to avoid this rare intraoperative complication would be to ensure that the surgical site is blocked with suitable regional nerve blocks using vasoconstrictors. This is routinely done during maxillofacial surgical procedures to ensure minimal bleeding and decrease postoperative pain. More importantly, local anesthesia blocks possible afferent pathways and prevents the reflex from occurring.2 I have personally never experienced TCR during maxillofacial surgical procedures, probably due to this reason. This is an easier alternative to prophylactic administration of vagolytic agents. A recorded instance of this complication during removal of a mesiodens was explained by possible inadequacy of local anesthesia in an already high-risk patient.