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Oculocardiac Reflex During Strabismus Surgery: Conjunctival Incision versus Standardized Rectus Muscle Traction.

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The Oculocardiac Reflex: A Review.

Robert W Arnold1

  • 1The Alaska OCR Study, Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK, 99508, USA.

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|July 1, 2021
PubMed
Summary
This summary is machine-generated.

The oculocardiac reflex (OCR), a common response during strabismus surgery, can cause profound bradycardia. While prediction remains difficult, careful anesthetic monitoring minimizes adverse outcomes from this trigemino-vagal reflex.

Keywords:
asystolebradycardiastrabismus surgerytrigeminovagal reflex

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Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Cardiology

Background:

  • The oculocardiac reflex (OCR) is a trigemino-vagal bradycardia typically induced by extraocular muscle (EOM) tension during strabismus surgery.
  • Other orbital stimuli, such as during retinopathy of prematurity examination, can also trigger cardiac slowing.

Purpose of the Study:

  • To analyze and review world literature on trigeminovagal and oculocardiac reflexes.
  • To compare anesthetic, patient, and surgical influences on OCR during strabismus surgery in an ongoing observational trial.

Main Methods:

  • Systematic review and analysis of over 15,000 patients from global literature, including 51 randomized clinical trials and case reports.
  • An ongoing observational trial in Alaska prospectively comparing anesthetic, patient, and surgical factors affecting OCR during strabismus surgery with uniform EOM tension.

Main Results:

  • Factors augmenting OCR include rapid-acting opioids, dexmedetomidine, older patients, the right eye, increased EOM tension, deeper inhaled agents, hypocarbia, anticholinergic medications, and orbital block.
  • OCR is reduced by less EOM tension, older patients, the right eye, deeper inhaled agents, hypocarbia, anticholinergic medications, and orbital block.
  • In re-operations, previous OCR responses are poor predictors of future events.

Conclusions:

  • Profound bradycardia occurs in approximately 10% of strabismus surgery cases without preventive anticholinergic measures.
  • Reliable prediction of OCR remains challenging, but careful anesthetic monitoring before EOM manipulation significantly reduces adverse sequelae.
  • The underlying mechanism for this cardiac response to eye surgery remains unknown despite extensive study.