Effects of an infratrochlear nerve block on reducing the oculocardiac reflex during strabismus surgery: a randomized controlled trial

Kim, Seung Hyun; Shin, Hyun Jin

doi:10.1007/s00417-018-4001-1

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…Strabismus surgery is a common ophthalmic surgical procedure, especially in pediatric patients. Postoperative nausea and vomiting (PONV) and intraoperative oculocardiac reflex (OCR) are the most frequent complications in patients undergoing strabismus surgery [1,2]. The incidence of PONV has been shown between 38 and 68.2% in pediatrics and 45.2% in adults following strabismus surgery [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

Sun

Cao

et al. 2021

BMC Anesthesiol

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Background Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery. Methods In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded. Results Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P < 0.01) and mitigated PONV severity as indicated by severity scoring (P < 0.01). Compared with normal saline, penehyclidine also significantly reduced OCR incidence (57.9% vs. 77.9%, P < 0.01) and mitigated OCR severity, as indicated by the requirement for atropine rescue (77.3% vs. 90.1%, P < 0.05) and the maximum decrease of heart rate during OCR (23.1 ± 9.4 bpm vs. 27.3 ± 12.4 bpm, P < 0.05). The recovery course did not differ between groups. Conclusions Penehyclidine administrated after anesthesia induction significantly reduced the incidence of PONV and alleviated intraoperative OCR in patients undergoing strabismus surgery. Trial registration ClinicalTrials.gov (NCT04054479). Retrospectively registered August 13, 2019.

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Section: Introductionmentioning

confidence: 99%

Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

Sun

Cao

et al. 2021

BMC Anesthesiol

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“… 26 Infratrochlear block reduced OCR defined as more than 15% bradycardia from 38% to 10% with planned EOM tension. 69 Analyzing n=264 patients from several randomized clinical trials of orbital block, a 35±26% reduction in incidence of OCR was accomplished with the block.…”

Section: Influence Of Anesthesiologistmentioning

confidence: 99%

“… 158 Kim and Shin found OCR (15% bradycardia) of 7% with conjunctival manipulation compared to unquantified muscle traction of 38%. 69 Rahimi et al described “the incision phase” which may include conjunctival and Tenon’s capsule dissection which had 16% incidence compared to greater 27% incidence during the “release phase” described as muscle manipulation.…”

Section: Influence Of Anesthesiologistmentioning

confidence: 99%

“…Kim and Shin noted highest incidence of 15% bradycardia OCR with muscle dissection 87% compared to incision 7% and medial rectus muscle traction 38% reduced to 20%, 3% and 10% in a group randomized to receive infratrochlear block. 69 Shin et al measured ECG and heart rate during the 156–161 mean seconds between lateral rectus and medial rectus hook to EOM “release.” 5 …”

Section: Influence Of Anesthesiologistmentioning

confidence: 99%

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The Oculocardiac Reflex: A Review

Arnold¹

2021

OPTH

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Background A typical oculocardiac reflex (OCR) is a moderate trigemino-vagal bradycardia elicited by tension on an extraocular muscle (EOM) during strabismus surgery; however, many other orbital stimuli can elicit cardiac slowing including retinopathy of prematurity examination. Methods World literature related to trigeminovagal and oculocardiac reflex covering over 15,000 patients including 51 randomized clinical trials and case reports are analyzed and reviewed. Under an ongoing observational trial in Alaska, anesthetic, patient and surgical influences on routine strabismus surgery using prospective, uniform EOM tension are compared seeking sufficient sample size to characterize this individually widely variable cardiac response. Results With adequate sample size, and emphasizing clinical studies controlling type of EOM, muscle tension amount and duration, anticholinergic and opioid medications, the following augment OCR; rapid-acting opioids and dexmedetomidine while OCR is reduced in older patients, the right eye, less EOM tension, deeper inhaled agents, hypocarbia, anticholinergic medications and orbital block. In re-operations, the former are relatively poor predictors of subsequent OCR. Conclusion Profound bradycardia can occur in almost 10% of strabismus surgery cases without anticholinergic preventive measures, but reliable prediction of OCR remains elusive. With foreknowledge and careful anesthetic monitoring of the patient before EOM manipulation, residual adverse sequelae from OCR are fortunately very rare. Despite well over a century of experience, the teleology for this occasionally dramatic cardiac response to eye surgery is still not known.

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“…Strabismus surgery is a common ophthalmic surgical procedure, especially in pediatric patients. Intraoperative oculocardiac re ex (OCR) and postoperative nausea and vomiting (PONV) are the most frequent complications following anesthesia and strabismus surgery (1,2). OCR, also known as the Aschner re ex, is de ned as a decrease in heart rate (HR) by greater than 20% following eyeball pressure or traction of the extraocular muscles (3).…”

Section: Introductionmentioning

confidence: 99%

Penehyclidine mitigates intraoperative oculocardiac reflex and postoperative nausea and vomiting in the patients with strabismus surgery: a prospective, randomized, double-blinded comparison

Sun

Cao

et al. 2020

Preprint

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BackgroundPONV is one of the most frequent complications following anesthesia and strabismus surgery. Penehyclidine, an anticholinergic, is widely and preoperatively used for reducing glandular secretion in patients. This study investigated the effect of penehyclidine on PONV in strabismus surgery.MethodsIn this prospective, randomized, and double-blinded study, patients of strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (NS, n = 104) groups. Penehyclidine was administrated immediately after anesthesia induction, and patients treated with NS served as controls. PONV was investigated within 48 h after surgery. Intraoperative OCR was also recorded.ResultsCompared with NS controls, penehyclidine significantly reduced PONV incidence [30.7% vs. 54.8%, P < 0.001] and mitigated PONV severity as indicated by severity scoring (P < 0.001). When stratified by gender and age, the reduction of PONV incidence following penehyclidine treatment was found significant in all adult patients and male underaged patients. Unexpectedly, penehyclidine also significantly reduced OCR incidence [57.9% vs. 77.9%, P < 0.01] and mitigated OCR severity which indicated by requirement of atropine to rescue [77.3% vs. 90.1%, P < 0.05]. Moreover, penehyclidine did not significantly change anesthesia recovery time, facial flushing and drowsiness occurrence compared to NS controls.ConclusionsPenehyclidine administration after anesthesia induction significantly attenuated intraoperative OCR and PONV in strabismus surgery patients.Trial registrationClinicalTrials.gov (NCT04054479). Registered July 19, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04054479?id=NCT04054479&draw=2&rank=1

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Effects of an infratrochlear nerve block on reducing the oculocardiac reflex during strabismus surgery: a randomized controlled trial

Abstract: An ITB maintains a stable HR and reduces the OCR during surgery on the MR. The ITB is less invasive and easily accessible to a surgeon, and can help improve the safety of strabismus surgery.

Cited by 10 publications

References 27 publications

Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

The Oculocardiac Reflex: A Review

Penehyclidine mitigates intraoperative oculocardiac reflex and postoperative nausea and vomiting in the patients with strabismus surgery: a prospective, randomized, double-blinded comparison

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