Trigeminal Cardiac Reflex in Post-Operative Spheno Orbital Menigioma

The trigeminal cardiac reflex (TCR) is a phenomenon that composed of bradycardia, arterial hypotension, apnoea, and gastric hypermobility. It most occur during skull base surgery at or around structures that are innervated by any sensory branch of the trigeminal nerve. We report a 48-year-old female who was diagnosed of having left spheno orbital meningioma and performed cranio-orbitozigomatic approach to remove the tumor. Six hours post-operative, she had sudden decreased in heart rate 31% decreased from base line, and also mean arterial blood pressure decreased 35% from base line. Laboratory finding was normal, oxygen saturation was 100% and no hypercarbia occurred. She was suspected to have trigeminal cardiac reflex. Intravenous administration of atropine abolished the reflex, heart rate and MABP slowly increased to normal.