We would like to thank Dr. Schaller for drawing our attention to his work on the trigemino-cardiac reflex (TCR). We are happy to report on almost identical findings from a very similar surgical procedure, which makes it likely that such instances occur more frequently than one might expect. In our setting, the ethmoidal ramus of the trigeminal nerve was directly stimulated by instruments, including withdrawal of blood and rinsing.

We are confident that the consequences of that stimulation resulted in a diving response (DR), which can be considered a TCR as it is apparently mediated by the trigeminal nerve . At first sight, the diving reflex should be excluded, as the patient was artificially ventilated. However, a number of authors have described that the DR can be triggered without breath-holding by merely immersing the face into water and continue breathing via a snorkel .

We agree with Dr. Schaller that this group of reflexes ought to be more widely known in order that their potentially grave consequences be averted.