Trigeminocardiac reflex in neurosurgical practice: Report of two new cases
A 52-year-old female was admitted because of decreased vision of about 8 months duration. She had no preoperative comorbidity. She was operated for a right clinoidal meningioma [Figure and ]. General anesthesia was given in usual standard manner (using medications as in the previous case). A right standard pterional craniotomy was performed and tumor could be resected totally using micro-dissection technique. Hemostasis was achieved and bone flap fixed and skin closed in routine fashion. Bandage was applied while the patient was still intubated. Attaching the subgaleal drain to the suction bottle, her HR dropped from 86/min to 45/min and BP from 110/85 to 75/43 mmHg. The suction was disconnected and the patient was taken to the recovery room and extubated. All the vital signs were normal in the recovery room but when connecting the drain to the vacuum bag, HR and BP dropped again. Lastly, she could not tolerate the vacuum drain and we had to attach it to the bag without negative pressure. No extra medications were administered and drain was removed the day after operation. The postoperative course was otherwise uncomplicated.