Intraoperative asystole during bilateral sagittal split osteotomy: An insight into the trigeminocardiac reflex

The trigeminocardiac reflex (TCR) occurs when branches of the trigeminal nerve are stimulated by physical and/or chemical triggers, leading to cardiac changes. It is commonly associated with midface manipulation, especially in the orbital region and similar incidents with mandibular procedures are not frequently reported. A girl in her late teens with no significant medical history or concurrent medications developed asystole during a bilateral sagittal split osteotomy (BSSO) under general anaesthesia. Prompt cardiopulmonary resuscitation led to the return of spontaneous circulation. The surgery was successfully completed post resuscitation.Although uncommon, similar episodes associated with manipulation of the mandibular division of the trigeminal nerve have been reported previously. This case describes a clinical presentation consistent with TCR during BSSO. Awareness of this potential association, prompt recognition, effective communication between the surgical and anaesthesiology teams, and timely management are essential for favourable outcomes.