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Lack of global vagal propensity in patients with oculocardiac reflex

R W Arnold1, A B Gould, R MacKenzie

  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

Ophthalmology
|August 1, 1994
PubMed
Abstract

Insights

Carotid sinus massage may predict bradycardia during eye surgery. This test showed greater heart rate slowing in patients prone to the oculocardiac reflex compared to controls.

Area of Science:

  • Ophthalmology
  • Cardiology
  • Anesthesiology

Background:

  • Profound bradycardia during ophthalmic surgery is a rare but serious complication.
  • The predictability of the oculocardiac reflex is not well understood.

Purpose of the Study:

  • To investigate the predictability of the oculocardiac reflex.
  • To compare vagotonic maneuver responses in patients with profound oculocardiac reflex versus control subjects.

Main Methods:

  • Six patients with profound oculocardiac reflex (3-10 second asystole) underwent four vagotonic maneuvers: diving response, Valsalva maneuver, ocular compression, and carotid sinus massage.
  • Results were compared to 30 previously studied control subjects.
  • Electrocardiographs monitored heart rate response during maneuvers.

Main Results:

  • Diving response, Valsalva maneuver, and ocular compression did not significantly differ between groups.
  • Carotid sinus massage produced significantly more bradycardia in patients (-24% +/- 6%) than controls (-12% +/- 7%) (P=0.01).
  • Heart rate response to ocular compression did not correlate with intraoperative oculocardiac reflex.

Conclusions:

  • Carotid sinus massage may serve as a predictor for intraoperative bradycardia during eye surgery.
  • Differences in heart rate sensitivity may stem from distinct sensory receptors and brain stem processing for the trigeminally mediated oculocardiac reflex.

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