A Hazard of Anæsthesia in Ophthalmic Surgery

Mallinson, F. Barnett; Coombes, Shannon

doi:10.1016/s0140-6736(60)92780-x

Cited by 22 publications

(6 citation statements)

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“…There have been conflicting opinions with regard to the effectiveness of retrobulbar anaesthesia on oculocardiac reflex [21, 22]. Moreover, retrobulbar block itself can stimulate oculocardiac reflex [23]. There have been no clinical trials to evaluate the efficacy of peribulbar anaesthesia on oculocardiac reflex.…”

Section: Discussionmentioning

confidence: 99%

Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery

2000

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SummarySixty premedicated, ASA physical status I or II patients weighing . 25 kg scheduled for elective retinal detachment repair were randomly assigned to receive either peribulbar block with 10 ml of 0.25% bupivacaine (block group) or intravenous morphine 150 mg.kg 21 (morphine group), prior to the induction of general anaesthesia (n 30 in each group). Patients were evaluated for intraoperative oculocardiac reflex , peri-operative pain relief, recovery from anaesthesia and postoperative nausea and vomiting. Apart from significantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block group patients had the maximum recovery score in the immediate postoperative period (80% vs. 27%, p , 0.0001) and they achieved complete recovery significantly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p , 0.0001). The incidence (40% vs. 77%, p 0.004) and severity of postoperative nausea and vomiting were significantly less in the block group. In summary, peribulbar bupivacaine, when administered together with general anaesthesia, attenuated oculocardiac reflex, provided comparable intra-operative and superior postoperative analgesia, resulted in significantly earlier and better recovery from anaesthesia, and significantly reduced the incidence and severity of postoperative nausea and vomiting.

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Section: Discussionmentioning

confidence: 99%

Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery

2000

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“…Landman and Ehrenfeld (1952) reported 'nearly fatal' ventricular fibrillation' after ocular compression for supraventricular tachycardia, but there was by presumption heart disease, and inspection of their illustrations suggests not fibrillation but ventricular tachycardia at worst. One unsubstantiated ancedotal warning is to be found in the literature: 'I am told that experts in the techniques of unarmed combat recognise that severe pressure on the eyes can cause syncope, and ifviolent enough, death' (Mallinson and Coombes, 1960). It therefore seems a wise precaution (which we take, like Lombroso and Lerman) to have resuscitation equipment available in the EEG room, even though the physician who performs the ocular compression will never need to use it.…”

Section: Discussionmentioning

confidence: 99%

Reflex anoxic seizures ('white breath-holding'): nonepileptic vagal attacks.

Stephenson¹

1978

Archives of Disease in Childhood

136

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SUMMARY From clinical history 58 children were diagnosed as having reflex anoxic seizures secondary to provoked cardioinhibition (also known as white breath-holding attacks). Before referral, these seizures were commonly misdiagnosed as epileptic either because the provocation was ignored, not recognised, or was a febrile illness, or because there was no crying, no obvious breath-holding, little cyanosis, and often no pallor to suggest syncope and cerebral ischaemia. The duration of cardiac asystole after ocular compression was measured in these children and in 60 additional children with other paroxysmal disorders. In 45 (78 %) of the 58 with reflex anoxic seizures asystole was 2 seconds or over, and in 32 (55 %) it was 4 seconds or greater, an abnormal response. Review of the literature supports the concept that these seizures result from vagal-mediated reflex cardiac arrest which can if necessary be prevented by atropine. The simple name 'vagal attack' is proposed. Ocular compression under EEG and ECG control supports the clinical diagnosis if asystole and/or an anoxic seizure is induced; the procedure described is safe and should be routine in seizure or syncope evaluation, when a meticulous history still leaves room for doubt.

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“…S ir —Oculocardiac reflex (OCR) results from traction on extraocular muscles, ocular manipulation or eye trauma. A number of cardiac arrests from OCR have been reported in the literature (1–3). However, to date pulmonary edema subsequent to cardiac arrest from OCR has not been reported.…”

mentioning

confidence: 99%

“…Fatal cardiac arrest because of OCR is uncommon and only two cases of death have been reported to date (2,3). In a death reported by Mallinson and Coombes, cerebral ischemia following repeated episodes of ventricular fibrillation from OCR was given as a cause (2). In another death, occult Epstein–Barr virus myocarditis was detected postoperatively (3).…”

mentioning

confidence: 99%