All about Cardiovascular Reflexes: Anesthesiologists Need to Know
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Published:
Nov 5, 2020
Keywords:
bradycardia, cardiovascular, CNS, hypotension, reflex, vagus
Main Article Content
Abstract
Cardiovascular reflexes are fast-action loops between
cardiovascular system and central nervous system (CNS)
that contribute to modulation of cardiac function in
physiologic homeostasis. Specific physiologic change
stimulated the specific cardiac receptors in various
pathways. CNS processed the response via sympathetic
and parasympathetic nervous system. These pathways
might be from physiologic change in cardiovascular
system. Cardiovascular reflexes were frequently observed
in perioperative period, mostly were hypotension and
bradycardia, such as baroreceptor reflex, Bezold-Jarisch
reflex, Bainbridge reflex. A properly understanding of these
reflexes may lead anesthesiologists for the early detection
and treatment of cardiovascular change in time.
Article Details
Section
Review articles
References
1. Gropper M, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen
N, Leslie K. Miller’s Anesthesia. 9th ed. Philadephia: Elsevier;
2020.
2. Campagna JA, Carter C. Clinical relevance of the Bezold-
Jarisch reflex. Anesthesiology 2003; 98: 1250-60.
3. Crystal GJ, Salem MR. The bainbridge and the “reverse”
bainbridge reflexes: history, physiology, and clinical relevance.
AnesthAnalg 2012; 114: 520-32.
4. Timmers HJLM, Wieling W, Karemaker JM, et al. Baroreflex
failure: a neglected type of secondary hypertension. The
Netherland J Med 2004; 62: 151-5.
5. Huikuri HV, Pikkujamsa SM, Airaksine KE, et al. Sex-related
differences in autonomic modulation of heart rate in middleaged
subjects. Circulation 1996; 94: 122-5.
6. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and
high blood pressure on baroreflex sensitivity in man. Circ
Res1971;29:424-31.
7. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young
WL. Miller’s Anesthesia. 7th ed. Philadephia: Churchill Livingstone;
2010.
8. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC.
Clinical anesthesia, 6th ed. Philadephia: Lippincott Williams
& Wilkins; 2009.
9. Hemmings HC, Hopkins PM. Foundations of anesthesia:
basic sciences for clinical practice. 2nd ed. Philadephia:
Elsevier; 2006.
10. Thomas CJ, Woods RL. Guanylyl cyclase receptors mediate
cardiopulmonary vagal reflex actions of ANP. Hypertension
2003; 41: 279-85.
11. Finucane BT. Complications of regional anesthesia. 2nd ed.
New York: Springer; 2007.
12. D’Alessio JG, Weller RS, Rosenblum M. Activation of the
Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy
using interscalene block. Anesth Analg 1995;
80:1158–62.
13. Liguori GA, Kahn RL, Gordon J, et al. The use of metoprolol
and glycopyrrolate to prevent hypotensive/bradycardic
events during shoulder arthroscopy in the sitting position
under interscalene block. Anesth Analg 1998; 87:1320–5.
14. Boettcher DH, Zimpfer M, Vatner SF. Phylogenesis of the
Bainbridge reflex. Am J Physiol 1982;242:R244-6.
15. Khurana I. Textbook of medical physiology. 1st ed. Kundli:
Elsevier; 2009.
16. Greene NM. Physiology of spinal anesthesia. Baltimore:
Williams&Wilkins, 1958.
17. Hemmings HC, Egan TD. Pharmacology and physiology for
anesthesia. 2nd ed. Philadelphia: Elsevier; 2019.
18. Paleczny B, Niewinski P, Rydlewska A, et al. Age-related
reflex responses from peripheral and central chemoreceptors
in health men. ClinAuton Res 2014; 24: 285-96.
19. Cushing H. Concerning a definite regulatory mechanism of
the vasomotor centre which controls blood pressure during
cerebral compression. Bull Johns Hopkins Hosp
1901;12:290-2.
20. Heymans C. The control of heart rate consequent to changes
in the cephalic blood pressure and in the intracranial
pressure. Am J Physiol 1928;85:498-505.
21. Tsai YH, Lin JY, Huang YY, et al. Cushing response-based
warning system for intensive care of brian-injured patients.
Clin Neurophysiol 2018; 129: 2602-12.
22. Kalmar AF, Aken JV, Caemaert J, et al. Value of Cushing
reflex as warning sign for brain ischaemia during neuroendoscopy.
Br J Anaesth 2005; 94: 791-9.
23. Meuwly C, Golanov E, Chowdhury T, et al. Trigeminal cardiac
reflex: new thinking model about the definition based
on a literature review. Medicine (Baltimore). 2015;94:e484.
24. Apt L, Isenberg S, Gaffney WL. The oculocardiac reflex in
strabismus surgery. Am J Ophthal 1973; 76: 533-6.
25. Schaller B, Cornelius JF, Prabhakar H, et al. The trigeminocardiac
reflex: an update of the current knowledge. J Neurosurg
Anesthesiol 2009; 21:187-95.
26. Baxandall ML, Thorn JL. The nasopharyngeal reflex. Anaesthesia
1988; 43: 480-1.
27. Arnold RW, Bond AN, McCall M, et al. The oculocardiac
reflex and depth of anesthesia measured by brain wave.
BMC Anesthesiology 2019; 9: 36.
28. Meuwly C, Chowdhury T, Sandu N, et al. Anesthetic influence
on occurrence and treatment of the trigemino-cardiac reflex:
a systematic literature review. Medicine (Baltimore)
2015;94:e807.
29. Chowdhury T, Sandu N, Meuwly C, et al. Trigeminocardiac
reflex: Differential behavior and risk factors in the course of
the trigeminal nerve. Future Neurol 2014; 9: 41-7.
30. Dabbous AS, Baissari MC, Nehme PW, et al. Perioperative
reflex bradycardia and cardiac arrest. Middle East J Anaesthesiol
2014;22:353-60.
N, Leslie K. Miller’s Anesthesia. 9th ed. Philadephia: Elsevier;
2020.
2. Campagna JA, Carter C. Clinical relevance of the Bezold-
Jarisch reflex. Anesthesiology 2003; 98: 1250-60.
3. Crystal GJ, Salem MR. The bainbridge and the “reverse”
bainbridge reflexes: history, physiology, and clinical relevance.
AnesthAnalg 2012; 114: 520-32.
4. Timmers HJLM, Wieling W, Karemaker JM, et al. Baroreflex
failure: a neglected type of secondary hypertension. The
Netherland J Med 2004; 62: 151-5.
5. Huikuri HV, Pikkujamsa SM, Airaksine KE, et al. Sex-related
differences in autonomic modulation of heart rate in middleaged
subjects. Circulation 1996; 94: 122-5.
6. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and
high blood pressure on baroreflex sensitivity in man. Circ
Res1971;29:424-31.
7. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young
WL. Miller’s Anesthesia. 7th ed. Philadephia: Churchill Livingstone;
2010.
8. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC.
Clinical anesthesia, 6th ed. Philadephia: Lippincott Williams
& Wilkins; 2009.
9. Hemmings HC, Hopkins PM. Foundations of anesthesia:
basic sciences for clinical practice. 2nd ed. Philadephia:
Elsevier; 2006.
10. Thomas CJ, Woods RL. Guanylyl cyclase receptors mediate
cardiopulmonary vagal reflex actions of ANP. Hypertension
2003; 41: 279-85.
11. Finucane BT. Complications of regional anesthesia. 2nd ed.
New York: Springer; 2007.
12. D’Alessio JG, Weller RS, Rosenblum M. Activation of the
Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy
using interscalene block. Anesth Analg 1995;
80:1158–62.
13. Liguori GA, Kahn RL, Gordon J, et al. The use of metoprolol
and glycopyrrolate to prevent hypotensive/bradycardic
events during shoulder arthroscopy in the sitting position
under interscalene block. Anesth Analg 1998; 87:1320–5.
14. Boettcher DH, Zimpfer M, Vatner SF. Phylogenesis of the
Bainbridge reflex. Am J Physiol 1982;242:R244-6.
15. Khurana I. Textbook of medical physiology. 1st ed. Kundli:
Elsevier; 2009.
16. Greene NM. Physiology of spinal anesthesia. Baltimore:
Williams&Wilkins, 1958.
17. Hemmings HC, Egan TD. Pharmacology and physiology for
anesthesia. 2nd ed. Philadelphia: Elsevier; 2019.
18. Paleczny B, Niewinski P, Rydlewska A, et al. Age-related
reflex responses from peripheral and central chemoreceptors
in health men. ClinAuton Res 2014; 24: 285-96.
19. Cushing H. Concerning a definite regulatory mechanism of
the vasomotor centre which controls blood pressure during
cerebral compression. Bull Johns Hopkins Hosp
1901;12:290-2.
20. Heymans C. The control of heart rate consequent to changes
in the cephalic blood pressure and in the intracranial
pressure. Am J Physiol 1928;85:498-505.
21. Tsai YH, Lin JY, Huang YY, et al. Cushing response-based
warning system for intensive care of brian-injured patients.
Clin Neurophysiol 2018; 129: 2602-12.
22. Kalmar AF, Aken JV, Caemaert J, et al. Value of Cushing
reflex as warning sign for brain ischaemia during neuroendoscopy.
Br J Anaesth 2005; 94: 791-9.
23. Meuwly C, Golanov E, Chowdhury T, et al. Trigeminal cardiac
reflex: new thinking model about the definition based
on a literature review. Medicine (Baltimore). 2015;94:e484.
24. Apt L, Isenberg S, Gaffney WL. The oculocardiac reflex in
strabismus surgery. Am J Ophthal 1973; 76: 533-6.
25. Schaller B, Cornelius JF, Prabhakar H, et al. The trigeminocardiac
reflex: an update of the current knowledge. J Neurosurg
Anesthesiol 2009; 21:187-95.
26. Baxandall ML, Thorn JL. The nasopharyngeal reflex. Anaesthesia
1988; 43: 480-1.
27. Arnold RW, Bond AN, McCall M, et al. The oculocardiac
reflex and depth of anesthesia measured by brain wave.
BMC Anesthesiology 2019; 9: 36.
28. Meuwly C, Chowdhury T, Sandu N, et al. Anesthetic influence
on occurrence and treatment of the trigemino-cardiac reflex:
a systematic literature review. Medicine (Baltimore)
2015;94:e807.
29. Chowdhury T, Sandu N, Meuwly C, et al. Trigeminocardiac
reflex: Differential behavior and risk factors in the course of
the trigeminal nerve. Future Neurol 2014; 9: 41-7.
30. Dabbous AS, Baissari MC, Nehme PW, et al. Perioperative
reflex bradycardia and cardiac arrest. Middle East J Anaesthesiol
2014;22:353-60.