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The association between the oculocardiac reflex and post-operative vomiting in children undergoing strabismus surgery
L E Allen1, S Sudesh, S Sandramouli
1Birmingham Children's Hospital, UK.
Insights
The oculocardiac reflex (OCR) during pediatric strabismus surgery is linked to post-operative vomiting (POV). Children experiencing an intraoperative OCR were 2.6 times more likely to vomit, suggesting a shared pathway.
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatrics
Background:
- Oculocardiac reflex (OCR) is a risk in ophthalmic surgery, especially pediatric strabismus surgery.
- Post-operative vomiting (POV) is common after strabismus surgery, sometimes requiring admission.
- The trigemino-vagal reflex arc is implicated in both OCR and high rates of POV.
Purpose of the Study:
- To investigate the association between intraoperative oculocardiac reflex (OCR) and subsequent post-operative vomiting (POV) in children undergoing strabismus surgery.
Main Methods:
- Studied 79 children (ages 1-13) undergoing strabismus surgery under standardized anesthesia.
- Defined a positive OCR as a ≥10% heart rate drop or dysrhythmia onset.
- Monitored for POV within 24 hours post-surgery.
Main Results:
- An intraoperative OCR occurred in 64.6% (51/79) of children.
- 29 (36.7%) children experienced POV within 24 hours.
- A significant association (p=0.01) was found: children with OCR were 2.6 times more likely to vomit.
Conclusions:
- There is a significant association between the occurrence of intraoperative OCR and subsequent POV in pediatric strabismus surgery.
- The shared trigemino-vagal pathway likely underlies this association.
- Findings suggest potential preventive strategies targeting this reflex arc.
Abstract:
The oculocardiac reflex (OCR) is a potentially serious complication of ophthalmic surgery which is most commonly elicited during paediatric strabismus surgery. Post-operative vomiting (POV) is also extremely common after such procedures and may result in admission following planned day-case surgery. Although many factors play a part in the occurrence of POV, stimulation of the trigemino-vagal reflex arc is thought to explain the particularly high rate of vomiting after strabismus surgery. The OCR and the vaso-vagal response share this neuronal pathway, the bradycardia of the OCR often being the only objective feature of the vaso-vagal response while the patient is anaesthetised. The aim of this study was to investigate the possible association between the occurrence of the OCR and subsequent POV in children undergoing strabismus surgery. We have studied this relationship in 79 children, aged between 1 and 13 years, undergoing strabismus surgery under standardised anaesthetic conditions. A positive OCR was regarded as a drop in heart rate of 10% or more, or the onset of a dysrhythmia. An intraoperative OCR was elicited in 51 (64.6%) of the 79 children, whilst 29 (36.7%) developed POV in the subsequent 24 h period. There was a significant association between a positive intraoperative OCR and POV (p = 0.01): children with a positive OCR were 2.6 times more likely to vomit than those without the reflex. We conclude that there is an association between the occurrence of the OCR and POV and discuss possible preventive strategies.