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<p>Intraoperative bradycardia is a well-recognized yet often under-analyzed complication during mastoid surgery. Although trigeminocardiac reflex is frequently implicated, several other neurocardiac reflexes and anesthetic factors may contribute, each requiring distinct management strategies. We report a 20-year-old female undergoing right mastoid exploration for chronic osteomyelitis who developed sudden intraoperative bradycardia during mastoid drilling. Prompt recognition, cessation of surgical stimulus, and targeted anesthetic intervention led to rapid hemodynamic stabilization without recurrence. This case highlights the diagnostic challenge of intraoperative bradycardia during mastoid surgery and reviews the spectrum of possible etiologies, including trigeminocardiac reflex, vestibulocardiac reflex, Bezold–Jarisch reflex, glossopharyngeal-vagal reflex, and other anesthetic-related causes. Differentiating among these mechanisms is crucial, as management differs substantially. A systematic, physiology-based approach to bradycardia during mastoid surgery allows timely diagnosis, appropriate intervention, and prevention of recurrence, thereby improving perioperative patient safety.</p>

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When the Heart Slows in the Mastoid: Anaesthetic Implications of Intraoperative Bradycardia During Otologic Surgery—A Case Report and Review of Literature

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Anik Goel,
  • Vijay Adabala,
  • K. C. Das,
  • Arijit Jotdar

摘要

Intraoperative bradycardia is a well-recognized yet often under-analyzed complication during mastoid surgery. Although trigeminocardiac reflex is frequently implicated, several other neurocardiac reflexes and anesthetic factors may contribute, each requiring distinct management strategies. We report a 20-year-old female undergoing right mastoid exploration for chronic osteomyelitis who developed sudden intraoperative bradycardia during mastoid drilling. Prompt recognition, cessation of surgical stimulus, and targeted anesthetic intervention led to rapid hemodynamic stabilization without recurrence. This case highlights the diagnostic challenge of intraoperative bradycardia during mastoid surgery and reviews the spectrum of possible etiologies, including trigeminocardiac reflex, vestibulocardiac reflex, Bezold–Jarisch reflex, glossopharyngeal-vagal reflex, and other anesthetic-related causes. Differentiating among these mechanisms is crucial, as management differs substantially. A systematic, physiology-based approach to bradycardia during mastoid surgery allows timely diagnosis, appropriate intervention, and prevention of recurrence, thereby improving perioperative patient safety.