Trigemino-cardiac reflex may be refractory to conventional management in adults

摘要

Dear Sir,We have read with great interest the recent article of Prabhakar et al. that points out some important aspects about how to prevent the trigeminocardiac reflex (TCR), which we have also pinpointed in our recent articles [5, 7, 9], But the case report of Prabhakar et al. is of great importance because it demonstrates clearly that application of intravenous anticholinergics to block the muscarinic receptors of the heart-either prophylactically or after the elicit of the reflex-cannot be alone a sufficient strategy to prevent further episodes of TCR [3, 4, 8] as it prevent the occurrence of bradycardia; this recommendation is especially and additionally based on (patho)physiological knowledge. One has therefore to assume that the (potential) adverse effects of epinephrine in combination with pretreatment by calcium-channel blockers eliminated by atropine in Prabhakar et al. case report are evoked by a reflex response through the efferent vagus nerve.