Incidence of the trigeminocardiac reflex at the maxillofascial surgery and septorhinoplasty operations and anesthesia relationship

Trigeminocardiac reflex (TCR) is a clinical situation that emerges during Maxillofacial surgery, can develop when areas stimulated by ophtalmic maxilar and mandibular branches of trigeminal nerves or trigeminal nerve is stimulated directly by itself characterized with bradicardio, asistoli or hypotension. Anesthetic and surgical approaches could both repress and strengthen TCR. In our study, we aim to observe if there exist any difference in the development of TCR between the patients that are used sevoflurane and desflurane. Patients that had septoplasty surgery operated using those 2 agents between 01.01.2016/31.12.2016 retrospectively. 60 patients aging 18-65 and classified as ASA 1-2 according to the anesthetic risks who had septoplasty were included in the study. Patients anesthetic forms were examined retrospectively. Patients applied propofol 2mg/kg ve rocuroium 0.6 mg/kg during anesthetic induction and inhalation anesthetic, remifentanil and rocuranium for maintenance were chosen. Patients experiencing cardioc pathology and taking medicine that lengthens QT distance (antiarrhythmic drugs, beta blockers, positive inotropic agents, antihypertensive agents, tricyclic antidepressant drugs, phenothiazine); patients with electrolit defect and cronic obstructive lungs, and cronic kidney failure; and patients intubated in more than 2 trials were excluded from the study. Patients heart rates (HR) was recorded 7 times in total basally and after each procedure: anesthetic spray, induction, local anesthesia application, surgical incision, suture of insion and 5 minutes after extubation. Their noninvasive arterial blood pressure, peripheral oxygen saturation (SpO2) level, end-tidal carbon dioxide (ETCO2) level, and QT and QTc were recorded as well. The drug dosage and anesthesia and the surgery duration were calculated. The patients were divided into two groups. The Group SR were administered sevoflurane as an inhalation anesthetic agent and the Group DR were administered desflurane as an inhalation anesthetic agent. 20 bpm of increase/decrease in heart rate was determined as a significant change. Although there were not significant variations detected in terms of SAP, DAP, MAP, HR, QT VE OTc durations, a significant timewise variation was detected between the two groups. During perioperative period and surgical and anesthetic manipulations variation in SAP, DAP, MAP, HR, QT VE OTc durations were observed. Variations in HR and tension values were improved without pharmacologic treatment. In conclusion, there was not a significant variation detected between the two groups in terms of TCR development. Thus, we think both anesthetic agents, sevoflurane and desflurane, can be safely administered on the muscles innervated by trigeminal nerve branches.We recommend to monitor patients' SAP, DAP, MAP, HR, QT and QTc durations closely during perioperative period. If TCR emerges, first intervention would be reducing the surgical and anesthesia manipulation, and if necessary stopping those procedures completely. If TCR continues, we recommend switching to the pharmacologic treatment agents. We believe more work is necessary to identify TCR and its subgroups in order to understand TCR's useful features better.