Adjustment in patients with asystole during strabismus surgery

To investigate whether patients who developed asystole during strabismus surgery under general anesthesia also develop asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients.

Retrospective, noncomparative interventional case series.

Adjustment was performed with topical anesthesia in four patients aged 28, 32, 50, and 53 years who exhibited asystole during strabismus surgery under general anesthesia. Blood pressure and electrocardiogram were monitored during the adjustment.

Adjustment was successfully completed in all patients without asystole. Two patients showed oculocardiac reflex (OCR), with a reduction in heart rate (HR) >20% of the baseline value. One of these patients exhibited severe OCR that developed when the patient's posture was changed from the supine to the sitting position for measurement of the angle of strabismus after adjustment, and again during conjunctival manipulation after conjunctival closure. No patient required atropine.

Adjustment can safely be performed under topical anesthesia in patients who developed asystole during strabismus surgery under general anesthesia.