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LETTER TO EDITOR
Year : 2014  |  Volume : 9  |  Issue : 4  |  Page : 234

Trigeminocardiac reflex may mimic symptoms of air embolism!


Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication10-Dec-2014

Correspondence Address:
Hemanshu Prabhakar
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.146622

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How to cite this article:
Prabhakar H. Trigeminocardiac reflex may mimic symptoms of air embolism!. Asian J Neurosurg 2014;9:234

How to cite this URL:
Prabhakar H. Trigeminocardiac reflex may mimic symptoms of air embolism!. Asian J Neurosurg [serial online] 2014 [cited 2019 Jun 19];9:234. Available from: http://www.asianjns.org/text.asp?2014/9/4/234/146622

Sir,

I read with interest the article by El-Zenati et al. [1] Air embolism during skull pin removal is not new and has been reported by us in 2008. [2] The incident in our patient had been documented and confirmed by transesophageal echocardiography (TEE) also. The occurrence of hypotension and bradycardia could have possibly been due to the trigeminocardiac reflex (TCR). [3] Simultaneously, reduction of end-tidal carbon dioxide could be secondary to severe hypotension. The TCR could be a better explanation in this patient as the authors fail to show evidence for the occurrence of air embolism. Air was neither aspirated or visualized using TEE. Moreover, the clinical condition improved after a bolus of 30 mg ephedrine and fluids, suggesting that the fall in end-tidal carbon dioxide could be due to systemic hypotension. The possibility of the TCR cannot be overlooked as the authors have not explained the exact sequence of events in the occurrence of air embolism.

 
  References Top

1.
El-Zenati H, Faraj J, Al-Rumaihi GI. Air embolism related to removal of Mayfield head pins. Asian J Neurosurg 2012;7:227-8.  Back to cited text no. 1
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2.
Prabhakar H, Ali Z, Bhagat H. Venous air embolism arising after removal of Mayfield skull clamp. J Neurosurg Anesthesiol 2008;20:158-9.  Back to cited text no. 2
    
3.
Schaller B, Cornelius JF, Prabhakar H, Koerbel A, Gnanalingham K, Sandu N, et al. The trigemino-cardiac reflex: An update of the current knowledge. J Neurosurg Anesthesiol 2009;21:187-95.  Back to cited text no. 3
    




 

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