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Peribulbar anaesthesia: failure to abolish the oculocardiac reflex
M Batterbury1, D Wong, R Williams
1St Paul's Eye Hospital, Liverpool.
Eye (London, England)
|January 1, 1992
Summary
Peribulbar anesthesia, commonly used in eye surgery, often fails to block the oculocardiac reflex. This reflex can cause dangerous bradycardia, necessitating cardiac monitoring during procedures.
Area of Science:
- Ophthalmology
- Anesthesiology
- Cardiology
Background:
- Peribulbar anesthesia is a regional anesthesia technique increasingly used for ophthalmic surgeries, including cataract, vitreo-retinal, and strabismus procedures.
- The oculocardiac reflex, a potential complication during eye surgery, involves bradycardia triggered by extra-ocular muscle manipulation.
Purpose of the Study:
- To evaluate the efficacy of peribulbar anesthesia in preventing the oculocardiac reflex during ophthalmic surgeries.
- To assess the incidence and severity of bradycardia associated with the oculocardiac reflex under peribulbar anesthesia.
Main Methods:
- The study monitored the oculocardiac reflex in 11 patients undergoing ophthalmic surgery with peribulbar anesthesia.
- The reflex was stimulated by applying traction to an extra-ocular muscle.
- Cardiac rhythm, specifically bradycardia and its duration, was observed throughout the procedures.
Main Results:
- Peribulbar anesthesia failed to abolish the oculocardiac reflex in 9 out of 11 patients.
- The reflex manifested as bradycardia in all affected patients.
- One patient experienced profound bradycardia, with asystole lasting five seconds.
Conclusions:
- Peribulbar anesthesia is not consistently effective in preventing the oculocardiac reflex during ophthalmic surgery.
- Continuous cardiac rhythm monitoring is recommended during procedures performed under peribulbar anesthesia.
- Availability of a vagolytic agent for immediate use is advised to manage bradycardia effectively.