Letter to the Editor: Peripheral trigemino-cardiac reflex

Excerpt

We have read with great interest the commentary of our colleague Prabhakar on our recent manuscript about the first description of the trigemino-cardiac reflex (TCR) [4]. However, he claims to have previously seen a peripheral TCR in his own series [3]. As the TCR is now better known, we realize that not every bradycardia is a TCR [1] and that is why we publish only cases in which we have excluded hemodynamic changes not related to TCR by our own strict definition [5‐7]. Regarding the case of the question of colleague Prabahakar, he speaks of a "sudden cardiac standstill" [2], but various differential diagnoses exist for a cardiac arrest during skin flap elevation. To decide such cases, we should await a larger case series before making further decisions. We need to conduct prospective studies with real-time second-to-second monitoring of the heart rate and blood pressure in conjunction with possible monitoring of the vagal activity so that we can determine a definite time and causal relationship between hemodynamic parameters and vagal activity. …