Abstract Mutations in SCN8A gene lead to changes in sodium channels in the brain, which are correlated with severe epileptic syndrome. Due to the rarity, there are few studies that support anesthesia in that population. The present study aims to report alternatives to inhalation anesthesia at epileptic encephalopathy. Case report: Male, 4 years old, with SCN8A encephalopathy with surgical indication of orchidopexy. Neuroaxis block was performed and dexmedetomidine was used as a pre-anesthetic and sedation. The anestheticsurgical act was uneventful. Conclusion: The association of neuraxial block and dexmedetomidine proved to be a viable alternative for surgery in patients with SCN8A encephalopathy.

Abstract Mutations in SCN8A gene lead to changes in sodium channels in the brain, which are correlated with severe epileptic syndrome. Due to the rarity, there are few studies that support anesthesia in that population. The present study aims to report alternatives to inhalation anesthesia at epileptic encephalopathy. Case report Male, 4 years old, with SCN8A encephalopathy with surgical indication of orchidopexy. Neuroaxis block was performed and dexmedetomidine was used as a pre-anesthetic and sedation. The anestheticsurgical act was uneventful. Conclusion The association of neuraxial block and dexmedetomidine proved to be a viable alternative for surgery in patients with SCN8A encephalopathy.

Resumo Justificativa: O reflexo trigêmino-cardíaco é um fenômeno fisiológico passível de ocorrer em cirurgias da cabeça e pescoço, e normalmente é benigno. Contudo, pode apresentar respostas exageradas, com grave morbidade. Relato de caso: Paciente masculino, 26 anos, candidato a tratamento cirúrgico de fratura do complexo zigomático-orbitário. Ato cirúrgico sem intercorrências com tamponamento nasal bilateral ao final. Após admitido na sala de recuperação pós-anestésica, queixou-se de “falta de ar” e náusea. A oximetria de pulso caiu abaixo 90% em ar ambiente e foi ofertado então O2 a 100% sob máscara de Hudson. Não houve melhora da oximetria e apresentou piora da dispneia, com sibilos difusos, redução da frequência cardíaca e da pressão arterial. Administrada atropina, que elevou a frequência cardíaca, mas sem resolução da hipotensão arterial e broncoespasmo. Aventamos a hipótese de reflexo trigêmino-cardíaco e então foi feita a remoção do tamponamento nasal com remissão completa dos sinais e sintomas. Discussão: Florian Kratschmer (1870) foi o primeiro a descrever as influências de reflexos da mucosa nasal na respiração e na circulação, o que ficou conhecido como reflexo de Kratschmer. Trata-se de um arco reflexo cuja aferência é originária nas terminações nervosas do nervo trigêmeo. A apresentação clínica do reflexo trigêmino-cardíaco é a ocorrência de súbita bradicardia, hipotensão, apneia e hipermotilidade gástrica. Conclusão: O reflexo trigêmino-cardíaco pode ser uma resposta neurogênica protetora, oxigênio-conservadora, de baixa morbidade, contudo exacerbada em determinadas situações. A interação entre cirurgião e anestesiologista, aliada à monitoração criteriosa da pressão arterial e do ritmo cardíaco, é fundamental para o diagnóstico e o tratamento.

Abstract Background: Trigeminocardiac reflex is a physiological phenomenon that may occur in head and neck surgery, and is usually benign. However, it may present with exaggerated responses with severe morbidity. Case report: Male patient, 26 years old, candidate for surgical treatment of zygomatic-orbital complex fracture. The surgery with bilateral nasal packing placed at the end of the procedure was uneventful. After being admitted to the post-anesthesia care unity, the patient complained of shortness of breath and nausea. Pulse oximetry fell below 90% in ambient air, and 100% O2 was then offered through a Hudson mask. He showed no improvement in oximetry and presented with worsening dyspnea, diffuse wheezing, reduced heart rate, and blood pressure. Atropine was given, which raised the heart rate, but without resolution of hypotension and bronchospasm. Our suspicion was of a trigeminal-cardiac reflex, and then the removal of the nasal packing was done with complete remission of the signs and symptoms. Discussion: Florian Kratschmer (1870) was the first to describe the influences of nasal mucosal reflexes on respiration and circulation, which became known as Kratschmer's reflex. It is a reflex arc whose afferent originates in the nerve endings of the trigeminal nerve. The clinical presentation of trigeminocardiac reflex is the occurrence of sudden bradycardia, hypotension, apnea, and gastric hypermotility. Conclusion: Trigeminocardiac reflex may be a protective neurogenic, oxygen-conserving response with low morbidity, however, exacerbated in certain situations. The interaction between surgeon and anesthesiologist, together with a careful monitoring of blood pressure and heart rate are fundamental for diagnosis and treatment.