A Comparison of the Incidence of the Oculocardiac and Oculorespiratory Reflexes During Sevoflurane or Halothane Anesthesia for Strabismus Surgery in Children

Allison, Celia E.; Lange, J.J. de; Koole, F. D.; Zuurmond, W. W. A.; Ros, Herman H.; Schagen, Nico T. van

doi:10.1097/00000539-200002000-00012

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…Several studies confirm that OCR is seen more often with halothane than with sevoflurane and isoflurane (15,16). In our study, bradycardia was seen in 29% (group R) and up to 53% (group S) of halothane anesthetics; in another study the frequency was 79% (15). In this latter study, ventilation was spontaneous, and 11 of the 51 children hypoventilated (SpO 2 < 95%, ETCO 2 > 60 mmHg).…”

Section: Discussionsupporting

confidence: 77%

Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide

Karanović

Jukić

Carev

et al. 2004

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 77%

Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide

Karanović

Jukić

Carev

et al. 2004

Acta Anaesthesiol Scand

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“…The continuous infusion of remifentanil induced more change in heart rate following EOM traction than sevoflurane. Allison et al [13] concluded that sevoflurane depressed vagal activity more than halothane. Bradycardia was less pronounced in patients receiving sevoflurane, when OCR happened.…”

Section: Discussionmentioning

confidence: 99%

Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery

Lee

et al. 2013

Korean J Anesthesiol

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BackgroundThe oculocardiac reflex (OCR) can be elicited during manipulation of the orbital structures in the strabismus correction surgery. A sinus bradycardia is the most common manifestation of OCR; and cardiac dysrhythmia and asystole may also occur. Various efforts to reduce OCR have been attempted, but without coherent outcome results.MethodsSixty one children, undergoing elective strabismus surgery, were randomly allocated into 2 groups: Group K received ketamine 1.0 mg/kg; and Group M received midazolam 0.15 mg/kg for induction of anesthesia. Anesthesia was maintained with 1-1.3 MAC of sevoflurane with 50% N2O in O2. Heart rate and blood pressure were measured 30 seconds before extraocular muscle (EOM) traction and immediately after traction. The OCR was defined as a decrease in heart rate more than 20% of the baseline heart rate, following manipulating EOM. Postoperative nausea and vomiting (PONV) and emergence agitation (EA) were assessed in postanesthetic care unit (PACU).ResultsBlood pressure before tightening EOM in Group K was higher than that in Group M (P < 0.05). However Δ HR (2.7 ± 15% vs. - 0.9 ± 16%) and incidence of OCR (10.0% vs. 19.4%) after traction an EOM were not different between the two groups. The occurrence of PONV (6.7 vs. 9.7%) and EA (30.0% vs. 22.6%) were similar.ConclusionsKetamine does not reduce the incidence of OCR compared with midazolam in pediatric strabismus surgery. In addition, ketamine does not increase the incidence of PONV and EA. In conclusion, it is reliable to use ketamine in pediatric strabismus surgery.

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“…However, as the duration of surgical vagal stimulation was uncertain, and the strength of surgical stimuli is widely different in various surgical procedures, it was unethical to apply equally predetermined doses of sevoflurane during the study period. Previous studies [19,20] have suggested that inappropriate anesthetic depth increases the incidence of the oculocardiac reflex during pediatric strabismus surgery. In this regard, we compared the sevoflurane concentrations and BIS values in both groups at the moment of significant reflex bradycardia, and these were comparable with respect to anesthetic depth.…”

Section: Discussionmentioning

confidence: 99%

Dose fentanyl injection for blunting the hemodynamic response to intubation increase the risk of reflex bradycardia during major abdominal surgery?

Kim

Park

Lee

et al. 2012

Korean J Anesthesiol

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BackgroundAlthough supplemental fentanyl has been widely used to blunt the hemodynamic responses to laryngoscopic intubation, its residual vagotonic effect may increase the risk of reflex bradycardia. We compared the incidence and severity of significant reflex bradycardia after a bolus injection of equivalent doses of fentanyl and remifentanil (control drug).MethodsIn this prospective, randomized, double-blind study, 220 adult patients undergoing major abdominal surgery were randomly assigned to receive fentanyl (1.5 µg/kg) or remifentanil (1.5 µg/kg). No anticholinergic prophylaxis was administered. Symptomatic reflex bradycardia was defined as a sudden decrease in heart rate to < 50 beats per minute (bpm) or to 50-59 bpm associated with a systolic arterial pressure < 70 mmHg in connection with surgical maneuvers. If bradycardia or hypotension developed, atropine or ephedrine was administered following a predefined treatment protocol.ResultsIn total, 188 subjects (remifentanil, 95; fentanyl, 93) were included. The proportion of subjects with symptomatic reflex bradycardia in the fentanyl group was similar to that in the remifentanil group (30.1% vs. 28.4%, respectively). Atropine and/or ephedrine were needed similarly in both groups. The differences between the group of 55 patients who presented with symptomatic reflex bradycardia were not statistically significant with respect to the lowest heart rate, anesthetic depth-related data (bispectral index and end-tidal sevoflurane concentration), or the proportion of causative surgical maneuvers.ConclusionsFentanyl (1.5 µg/kg) administered intravenously during anesthetic induction is unlikely to increase the incidence and severity of significant reflex bradycardia in patients undergoing major abdominal surgery.

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A Comparison of the Incidence of the Oculocardiac and Oculorespiratory Reflexes During Sevoflurane or Halothane Anesthesia for Strabismus Surgery in Children

Abstract: Some children experience a sudden slowing of the heart and impaired breathing when the surgeon pulls on the eye muscles during squint operations under anesthesia. Sevoflurane, a recently developed anesthetic vapor, may reduce this problem when compared with the established vapor halothane.

Cited by 31 publications

References 16 publications

Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide

Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide

Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery

Dose fentanyl injection for blunting the hemodynamic response to intubation increase the risk of reflex bradycardia during major abdominal surgery?

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