Volume 2008, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426


Hypotension and bradycardia after application of suction to a subgaleal drain, or stimulus inside or outside the skull, have been reported in the medical literature. The commonly reported occurrence is stimulation of the Trigeminal nerve along its distribution and is the main factor that sets off the whole reflex arc through the Vagus nerve ending in a series of serious hemodynamic changes that institute severe bradycardia, asystole and severe hypotension. Another less common but possible patho logy caused by a suction drain is Pseudo-Hypoxic Brain Swelling (PHBS). We report a case of transient cardiac arrest after the application of theatre suction to a subgaleal drain at the closure of an uneventful craniotomy and discuss the possibilities as well as review the literature.


Article metrics loading...

Loading full text...

Full text loading...


  1. McCulloch GAJ, Pattison WJ. Circulatory changes caused by a closed, negative pressure drainage system after craniotomy. Neurosurgery. 1981; 9::380382.
    [Google Scholar]
  2. Jacka M, Wood G. Bradycardia related to sudden decrease in intracranial pressure during craniotomy. Anesth Analg. 1994; 78::10221023.
    [Google Scholar]
  3. Wasnick JD. Unexplained bradycardia during craniotomy closure: The role of intracranial hypotension. Anesth Analg. 1993; 76::432433.
    [Google Scholar]
  4. Campbell R, Rodrigo D, Cheung L. Asystole and bradycardia during maxillofacial surgery. Anesth Prog. 1994; 41::1316.
    [Google Scholar]
  5. Karamchandani K. Severe bradycardia and hypotension after connecting negative pressure to the subgaleal drain during craniotomy closure. Br J Ahaesth. 2006; 96::608610.
    [Google Scholar]
  6. Hernandez-Palazon J. Cardiovascular disturbances caused by extradural negative pressure drainage systems after intracranial surgery. Br J Anaesth. 1998; 80::599601.
    [Google Scholar]
  7. Alfrey D, Shapiro , Gagnon R. Cardiac arrest following rapid drainage of cerebrospinal fluid in a patient with hydrocephalus. Anesthesiology. 1980; 52::443444.
    [Google Scholar]
  8. Van Roost D. Pseudohypoxic Brain Swelling: A newly defined complication after uneventful brain surgery, probably related to suction drainage. J. Neurosurgery. 2003; 53::13151325.
    [Google Scholar]
  9. Walter Fiirst MS, Asmita Banerjee. Release of Glutaraldehyde from an Albumin-Glutaraldehyde Tissue Adhesive Causes Significant In Vitro and In Vivo Toxicity. Ann Thorac Surg. 2005; 79::15221529.
    [Google Scholar]
  10. BioGlue Surgical Adhesive: Reported incidents of chronic inflammation and foreign-body reactions, Canadian Adverse Reaction Newsletter, October 2006, Volume 16, Issue 4.
  11. Schaller B. Trigeminocardiac reflex a clinical phenomenon or a new physiological entity? J Neurol. 2004; 251::658665.
    [Google Scholar]
  12. Schaller B, Michael Buchfelder. Trigemino-Cardiac Reflex: A recently discovered “oxygen-conserving” response? The potential therapeutic role of a physiological reflex. Arch Med Sci. 2006; 2,1::35.
    [Google Scholar]
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error