A long NPA can cause bradycardia due to stimulation of which nerve?

• A. Vagal nerve
• B. Glossopharyngeal nerve
• C. Trigeminal nerve
• D. Hypoglossal nerve

Answer: (A)

Stimulation of the vagus nerve can slow the heart. A long nasopharyngeal airway can irritate the nasal/pharyngeal mucosa and trigger a vagal reflex, increasing parasympathetic tone to the heart and causing bradycardia. This is a recognized airway management consideration in children, who may be more sensitive to vagal stimulation. If bradycardia occurs, remove or reposition the NPA and reassess the airway while monitoring the heart rate. The other nerves listed do not mediate this heart-rate–slowing reflex from nasopharyngeal stimulation.