What is the most the appropriate course of action? - Answer & Explanation
- Administration of vasodilators
- Administration of anticholinergics to halt the trigeminocardiac reflex
- Stop the irrigation and check for egress of irrigating fluid to reduce the ICP ✓ Correct Answer
- Deepening the plane of anaesthesia and neuromuscular blockade
Explanation:
A 6-month-old infant is undergoing an endoscopic third ventriculostomy for obstructive hydrocephalus under general anaesthesia. Intraoperatively, during the endoscopic visualization of foramen of Munroe there was an episode of hypertension followed by bradycardia (HR drops suddenly to 45/min from 110/min). What is the most the appropriate course of action?
a. Administration of vasodilators
b. Administration of anticholinergics to halt the trigeminocardiac reflex
c. Stop the irrigation and check for egress of irrigating fluid to reduce the ICP
d. Deepening the plane of anaesthesia and neuromuscular blockade
Answer: C
During Endoscopic Third Ventriculostomy Cushings reflex can be triggered by sudden increase in Intra Cranial Pressure (ICP) due to continuous ventricular irrigation. The solutions is to stop the irrigating fluid and check for egress of fluid to reduce the ICP.
Reference
van Aken J, Struys M, Verplancke T, de Baerdemaeker L, Caemaert J, Mortier E. Cardiovascular changes during endoscopic third ventriculostomy. Minim Invasive Neurosurg. 2003 Aug;46(4):198-201. doi: 10.1055/s-2003-42354. PMID: 14506561.