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Comparative Study of Trigeminocardiac Reflex After Trigeminal Ganglion Compression During Total Intravenous Anesthesia

Wang, Chang-Ming MD*; Guan, Zhan-Ying MD; Zhang, Jing MD*; Cai, Chang-Hua MD*; Pang, Qing-Gui MD*; Wang, Rong-Wei MD*; Liu, Hui MD*; Liu, Yan-Fang MD*; Yin, Mei-Hua MD*; Ma, Yi MD

Journal of Neurosurgical Anesthesiology: January 2015 - Volume 27 - Issue 1 - p 16–20
doi: 10.1097/ANA.0000000000000076
Clinical Investigations
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Background: Percutaneous compression of the trigeminal ganglion (PCTG) is an alternative surgical treatment for trigeminal neuralgia (TN). Manipulation of PCTG can lead to significant hemodynamic changes, which may increase the risk of cardiovascular complications. However, to our knowledge, few studies have focused on anesthesia experience during PCTG as treatment for TN so far. It was our primary focus on how to ensure the stability of hemodynamics during our clinical anesthesia experience. This study aimed to compare the study group (using sodium nitroprusside [SNP] as soon as the puncture began) with the control group (without using SNP as soon as the puncture began) to investigate cardiovascular parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate [HR]) at 5 periods during total intravenous anesthesia.

Methods: A total of 256 patients who underwent PTCG were enrolled and randomly assigned into the study group (n=137) (using SNP as soon as the puncture began) and the control group (n=119) (without using SNP as soon as puncture began); the relationship between the hemodynamic changes and using SNP or without using SNP was compared. Blood pressure and HR were measured at 5 periods: preoperative (T1), before puncture (T2), during compression (T3), 1 minute after compression ended (T4), and 1 minute after the procedure ended (T5). Multivariate analysis of variance and the Pearson χ2 test were used, and a value of P<0.05 was considered statistically significant.

Results: The mean values of SBP were higher in the control group at the evaluation during T3 (P<0.001 vs. control), T4 (P<0.05 and P=0.040 vs. control), and T5 (P<0.05 and P=0.037 vs. control) and DBP was the only observed significant difference during T3 (P<0.001 vs. control), when compared with the study group. Meanwhile, means of SBP, DBP, and HR comparison in the same group were observed between T2 and T3. In the control group, means of SBP (P<0.001 vs. T2), DBP (P<0.001 vs. T2), and HR (P<0.001 vs. T2) showed significant differences in comparison with control group; means of HR (P<0.001 vs. T2) was the only observed significant difference between T2 and T3 in the study group. However, PTCG elicited significant abrupt bradycardia during T3 in almost all patients.

Conclusions: The control group and the study group were not able to prevent bradycardia elicited during PTCG. Compared with control group, dramatic elevations of the systemic blood pressure can be prevented using intravenous drip SNP as soon as the puncture began during total intravenous anesthesia in the study group. Our findings verify that intravenous drip SNP is an effective method to control abrupt rise of blood pressure.

*Department of Anesthesiology

Second Department of Neurosurgery, Liao Ning Provincial People’s Hospital

Department of Anesthesiology, Branch Hospital of Hunnan, The General Hospital of Shen Yang Military Region, Shen Yang, China

C.-M.W. and Z.-Y.G. contributed equally.

Supported by the Department of Anaesthesiology and the Second Department of Neurosurgery, Liao Ning Provincial People’s Hospital, P.R. China.

Corresponding author Chang-Ming Wang and Chang-Hua Cai, the authors have no funding or conflicts of interest to disclose.

Reprints: Chang-Ming Wang, MD, and Chang-Hua Cai, MD, Department of Anesthesiology, Liao Ning Provincial People’s Hospital, Shen Yang 110016, China (e-mail: wchangming@163.com).

Received December 15, 2013

Accepted March 26, 2014

© 2015 by Lippincott Williams & Wilkins