A Retrospective Study On The Incidence Of Trigemino-cardiac Reflex During Functional Endoscopic Sinus Surgery

Objective: To investigate the occurrence,clinical features,risk factors and management of trigemino-cardiac reflex(TCR)during functional endoscopic sinus surgery.Methods: A retrospective analysis was performed on the patients who underwent functional endoscopic sinus surgery under general anesthesia from January 2016 to December 2017 in Wuhan Union Hospital.All the clinical data were collected.The patients were divided into group A and group B according to the different surgeons.According to the different preoperative diagnosis,the patients were divided into nasal cavity,sinus,nasopharynx and other surgical groups.According to the electronic anesthesia monitoring,we picked out all the patients who suffered from TCR during the operation(TCR was defined as a drop in the heart rate(HR)of more than 20% to the baseline values while the operation involved the trigeminal nerve distribution area which is not related to anesthetic factors,and HR could return to the baseline level after the operation is stopped or the drug is used).They were divided into TCR group and non-TCR group,and the changes of hemodynamics at different time points were compared.To analyze whether the patients with TCR had basic diseases before operation and the management during operation.Results: A total of 695 patients were collected,including 447 males and 248 females,aged3~82 years,with ASAI~IV grade,fourteen patients occurred TCR events intraoperatively.The baseline heart rate of 14 patients was 67.9+11.4 /min,and dropped to 49.9+8.9 /min when TCR occurred,the heart rate after recovery was 68.3+9.7 /min,The lowest heart rate was 39 /min,and no cardiac arrest occurred.The heart rate at TCR was significantly different from the baseline heart rate and the heart rate after recovery(P<0.05).There were no significant differences in gender,age,ASA classification,operation duration and anesthesia duration between TCR and non-TCR groups(P > 0.05),but the incidence of TCR in children was higher than that in adults.There was no significant difference in the frequency of TCR between group A and group B.There was no significant difference in the frequency of TCR in nasal cavity,sinus,nasopharynx and other surgical groups,but the incidence of TCR in nasopharyngeal surgery group was slightly higher than that in other groups.Among the fourteen patients,three patients had basic diseases before operation,and the other eleven patients had no records of basic diseases.Four patients were treated with ephedrine while TCR occurred.Three patients were treated with 5mg and one with 10 mg,and their heart rates were restored to the baseline level.The rest patients did not use the relevant drugs to restore normal heart rate.Conclusion: TCR may occur in functional endoscopic sinus surgery,with an incidence of2.01%.Its clinical features include not only bradycardia,but also a drop in blood pressure.Cardiovascular changes caused by TCR are relatively short,but may cause serious bradycardia.Although no cardiac arrest occurs in this article,surgeons and anesthesiologists should attach great importance to it.TCR should be recognized early and the drug intervention is needed in severe bradycardia,ephedrine is one of the effective drugs.Relevant risk factors need to be further validated.