The following is a summary of “Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery,” published in the July 2023 issue of the Dermatologic Surgery by Poe et al.
The trigeminocardiac reflex is a frequent but underreported phenomenon that can range from harmless to fatal. This reflex can be evoked by applying direct pressure to the globe of the eye or by stimulating the trigeminal nerve through traction of the extraocular muscles. The goal is to examine potential stimuli for the trigeminocardiac reflex in dermatologic surgery and to discuss treatment options for the trigeminocardiac reflex.
Utilizing PubMed and Cochrane, the researchers identified articles and case reports that described scenarios in which the trigeminocardiac reflex was triggered and how the reflex was subsequently managed. In dermatologic surgery, the trigeminocardiac reflex can be triggered during office-based biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions. Significant bradycardia, hypotension, gastric hypermobility, and lightheadedness are the most prevalent manifestations.
The most effective treatment is cessation of the inciting stimulus, monitoring, and managing symptoms. Glycopyrrolate and atropine are frequently used to treat severe, intractable cases of the trigeminocardiac reflex. The trigeminocardiac reflex, despite being underreported and underrepresented in dermatological literature and surgical contexts, should be considered in the presence of bradycardia and hypotension during dermatological procedures.