Open AccessIntra-Arterial Lidocaine Blunts the Trigeminocardiac Reflex during Endovascular Treatment of a Carotid-Cavernous Fistula
Author(s) -
Renee L. Coleman,
Dmitri Bezinover,
Douglas C. Jones,
Kevin M. Cockroft,
Uma R. Parekh
Publication year - 2021
Publication title -
case reports in anesthesiology
Language(s) - English
Resource type - Journals
eISSN - 2090-6390
pISSN - 2090-6382
DOI - 10.1155/2021/2342347
Subject(s) - medicine , embolization , cavernous sinus , carotid cavernous fistula , reflex , bradycardia , lidocaine , efferent , neurovascular bundle , fistula , surgery , anesthesia , radiology , blood pressure , anatomy , afferent , heart rate
Carotid-cavernous fistulas (CCFs) are vascular shunts that allow blood to flow from the carotid artery or its branches into the cavernous sinus. Endovascular embolization is the treatment modality of choice. The trigeminocardiac reflex (TCR) is a vagally mediated reflex that can lead to hemodynamic instability. It can be activated during embolization procedures due to the proximity of vagal efferent neurovascular structures within the cavernous sinus. This case report describes the intraoperative management of recurrent, profound bradycardia due to TCR during endovascular CCF embolization.