{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:46:51Z","timestamp":1789213611931,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The trigeminocardiac reflex (TCR) is a potent brainstem response often underrecognized during pediatric dental procedures. We aimed to quantify TCR dynamics, identifying procedural and temporal predictors of occurrence and resolution. Methods: We conducted a prospective observational study (NCT07240688) in pediatric patients undergoing dental procedures under standardized sevoflurane anesthesia. TCR was defined as a \u226510% (mild) or \u226520% (severe) abrupt decrease in heart rate (HR) and\/or mean arterial blood pressure (MABP). Data were analyzed using Generalized Estimating Equations (GEE) and hierarchical logistic regression to identify procedural risk factors and recovery dynamics. Results: The study included 85 pediatric patients (aged 2\u20139 years) undergoing 1115 monitored dental procedures. The overall TCR incidence was 82.3% (n = 70). Operative duration was the strongest predictor of occurrence; each 1 min increase raised TCR odds by 6.7% (aOR: 1.067, p &lt; 0.001). A landmark \u201c60-min Autonomic Cliff\u201d was identified: the probability of rapid spontaneous recovery dropped from 97.1% before 60 min to 0.0% thereafter (p &lt; 0.001). Pulpal involvement was associated with a 3.37-fold increase in odds of severe TCR (Cramer\u2019s V = 0.747). While lingual manipulation was strongly associated with rapid resolution (OR: 650.04), deep pulpal maneuvers led to a state of \u201cVagal Lock-in\u201d\u2014a sustained bradycardic response with reduced spontaneous recovery\u2014effectively neutralized by atropine (97.0% success). Conclusions: Pediatric TCR is a time-dependent autonomic phenomenon in which operative duration influences reflex susceptibility and recovery dynamics, without affecting reflex severity. Beyond the \u201c60-min Autonomic Cliff,\u201d spontaneous recovery becomes unlikely, marking a transition to a refractory physiological state rather than an increase in reflex severity. This threshold provides a clinically actionable signal for anesthesiologists to intensify monitoring and consider early vagolytic intervention, supporting anticipatory, time-guided intraoperative management.<\/jats:p>","DOI":"10.3390\/jcm15103606","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:10:52Z","timestamp":1778267452000},"page":"3606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trigemino-Vagal Recalibration in Pediatric Anesthesia: A Prospective Cohort Study on the \u201c60-Minute Autonomic Cliff,\u201d \u201cTrigger Mass,\u201d and Recovery Dynamics in 1115 Dental Procedures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7055-547X","authenticated-orcid":false,"given":"G\u00f6zde Nur","family":"Erkan","sequence":"first","affiliation":[{"name":"Anesthesiology and Reanimation, Clinic of Anesthesiology, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, K\u0131r\u0131kkale University, 71450 K\u0131r\u0131kkale, T\u00fcrkiye"},{"name":"Department of Statistics, Faculty of Engineering and Natural Sciences, K\u0131r\u0131kkale University, 71450 K\u0131r\u0131kkale, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Meuwly, C., Chowdhury, T., Sandu, N., Golanov, E., Erne, P., Rosemann, T., and Schaller, B. 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