Intraoperative Bradycardia in a Child with Orbital Glioma: A Case of Trigeminocardiac Reflex

Trigeminocardiac Reflex (TCR) is a life-threatening but rare neurogenic reflex that can manifest during neurosurgical procedures. It presents as sudden bradycardia, hypotension, or even asystole triggered by stimulation of the trigeminal nerve. It is more frequent in children due to heightened vagal tone. Authors hereby, present the case of an 11-year-old male with a right-sided optic nerve glioma with intracranial extension who was electively operated on for tumour removal. The patient had a history of loss of vision in the right eye, ptosis, and seizures treated with levetiracetam. During intraoperative dissection near the superior orbital fissure and cavernous sinus, he suddenly developed bradycardia and hypotension, characteristic of TCR. The anaesthetic team promptly identified the reflex and implemented prompt management by alerting the surgical team to cease dissection, administering intravenous atropine, increasing FiO2 , and deepening the level of anaesthesia. The patient’s vital signs returned to baseline within minutes, and the surgery proceeded uneventfully. He was successfully weaned on postoperative day 2 without neurological sequelae. The case underscores the necessity of anticipation and vigilance for TCR in paediatric neurosurgical procedures involving trigeminal nerve regions. Early recognition and timely, coordinated intervention by surgical and anaesthetic teams are crucial to ensure haemodynamic stability and optimal patient outcomes. Preventive anaesthetic management, anticipating reflex phenomena, is of utmost importance in the perioperative management of such high-risk procedures.