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Neuromuscular Blockade Depth and Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial
Jung-Bin Park1, Jae Ho Jung2, Sang-Hwan Ji1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Anesthesiology
|July 16, 2026
Summary
Deeper neuromuscular blockade significantly reduces the incidence and severity of the oculocardiac reflex (OCR) in pediatric strabismus surgery. This suggests that moderate-to-deep blockade is an effective strategy to prevent OCR during eye muscle manipulation.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Ophthalmology
Background:
- The oculocardiac reflex (OCR) can occur during strabismus surgery.
- Neuromuscular blockade is known to reduce OCR, but the effect of blockade depth is not well understood.
Purpose of the Study:
- To investigate whether the depth of neuromuscular blockade influences the incidence of OCR during pediatric strabismus surgery.
Main Methods:
- A prospective, double-blinded randomized controlled trial involving 204 pediatric patients (3-18 years) undergoing strabismus surgery.
- Patients were randomized to moderate-to-deep neuromuscular blockade (MD-NMB) or minimal-to-shallow neuromuscular blockade (MS-NMB).
- OCR was defined as a ≥20% decrease in heart rate; severe OCR was defined as a ≥30% decrease.
Main Results:
- The incidence of OCR (grade ≥2) was significantly lower in the MD-NMB group (30.3%) compared to the MS-NMB group (53.9%).
- Severe OCR (grade ≥3) was also reduced in the MD-NMB group (18.2% vs. 35.3%).
- The magnitude and duration of heart rate reduction were smaller in the MD-NMB group among patients who developed OCR.
Conclusions:
- Moderate-to-deep neuromuscular blockade significantly reduces the incidence and severity of OCR during pediatric strabismus surgery.
- Deeper neuromuscular blockade is an effective strategy to attenuate OCR during extraocular muscle manipulation.
