Severe Bradycardia During Neurosurgical Procedure: Depth of Anesthesia Matters and Leads to a New Surrogate Model of the Trigeminocardiac Reflex

Hemodynamic alterations are observed in various neurosurgical procedures and commonly related to different neurogenic mechanisms. However, anesthetic influences on causation of these perturbations or management are rarely investigated and therefore our present knowledge is still limited.In this case of 43-old Caucasian male, propofol boluses aborted the trigeminal cardiac reflex (TCR) induced severe bradycardia during dural manipulation. There is a correlation of severity of bradycardia and slightness of anesthesia.In the light of the larger distribution of the TCR all over the world, we see more and more aborted TCR, as seen in the present case; then the neuro-anesthesists more and more recognize the TCR at its very onset. A surrogate model for the daily use is present to underline the clinical needs.We have therefore developed, for the first time, a surrogate model that helps in daily practice to recognize and prevent TCR episodes.