Document Detail

Computer-assisted paranasal sinus operation induces diving bradycardia.
MedLine Citation:
PMID:  23332411     Owner:  NLM     Status:  Publisher    
Unintentional mechanical manipulation anywhere in the distribution of the trigeminal nerve might activate a reflexive bradycardia. Neurosurgeons need to bear in mind detrimental consequences on cardiac function. A female patient (53 years) underwent a computer-assisted (CAS), paranasal sinus operation performed under general anesthesia. During left sided CAS and preparation of the sinus ethmoidalis, heart rate significantly fell from 68 to 32 /min, while systolic arterial blood pressure decreased from 105 to 75 mmHg. Continuation of the preparation again decreased heart rate progressing to transient asystole lasting for 15 s. After removal of the instruments, asystole terminated without medical support. As heart rate decreased after renewed insertion of the CAS probe, sinus ethmoidalis surgery was completed after atropine administration. During neurosurgical procedures, the incidence of the reflex varies between 10 and 18%. To the best of our knowledge, we report for the first time on a direct stimulation of the ethmoidal nerve with instruments (CAS probe) during paranasal surgery. Although normally cardioprotective, exaggeration of the diving reflex can be detrimental and has been implicated in cardiorespiratory disorders, including sudden death and the sudden infant death syndrome.
Jochen D Schipke; Sinclair Cleveland; Christian Caspers
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-14
Journal Detail:
Title:  American journal of otolaryngology     Volume:  -     ISSN:  1532-818X     ISO Abbreviation:  Am J Otolaryngol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8000029     Medline TA:  Am J Otolaryngol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Research Group Experimental Surgery, University Hospital Düsseldorf, DE. Electronic address:
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