METHODS: A 50-year-old female patient with a 4-year history of drug-resistant left trigeminal neuralgia. She was scheduled for surgical microvascular decompression. In the operating room, after induction of general anesthesia and oral intubation, the electrocardiogram revealed a significant ST segment elevation along with a sudden decrease in systolic blood pressure and heart rate. Administration of atropine caused a conversion into ventricular tachycardia. The advanced cardiac life support protocols were applied with prompt defibrillation and rapid recovery at sinus rhythm. A transthoracic echocardiogram revealed apical akinesia with ballooning of the left ventricle with a reduction of systolic function. An emergency coronary arteriography was performed, showing normal epicardial coronary vessels. After 4 days, echocardiography revealed normalization of the left ventricular function with improvement of the ejection fraction.
CONCLUSIONS: In patients affected by trigeminal neuralgia, chronic pain can lead to a state of adrenergic hyperactivation, which can promote TS during the induction of general anesthesia, probably through the trigeminocardiac reflex.
方法:一名50岁女性患者,有4年耐药左三叉神经痛病史。她被安排进行微血管减压手术。在手术室里,全身麻醉诱导和口腔插管后,心电图显示明显的ST段抬高,同时收缩压和心率突然下降.阿托品的给药引起室性心动过速的转变。先进的心脏生命支持方案应用于快速除颤和窦性心律快速恢复。经胸超声心动图显示心尖运动障碍,左心室膨胀,收缩功能降低。进行了紧急冠状动脉造影,显示心外膜冠状血管正常.4天后,超声心动图显示左心室功能正常化,射血分数改善。
结论:在受三叉神经痛影响的患者中,慢性疼痛会导致肾上腺素能过度激活状态,在全身麻醉诱导过程中可以促进TS,可能是通过三叉神经心脏反射.