The trigeminocardiac reflex（TCR）is a nerve reflex characterized by sudden onset of bradycardia, asystole, and hypotension upon peripheral or central stimulation of the trigeminal nerve. There are reports of TCR-induced bradycardia, sinus arrest, and asystole during craniomaxillofacial fracture surgeries. However, reports of asystole due to TCR during zygomatic fracture repair are very rare. Administering shallow anesthesia is one of the risk factors for TCR; additionally, pain and perineuromuscular stimulation caused by the insertion of an orthostatic device in zygomatic fracture repair are known triggers. We report a case of asystole involving a 61-year-old male patient who underwent TCR during zygomatic fracture repair, which neither the plastic surgeon nor anesthesiologist noticed immediately. The possibility of asystole due to TCR during zygomatic fracture repair and its effects should be known not only by the attending plastic surgeons and anesthesiologists, but also the staff involved in the surgery.
