Intraoperative cardiac arrest because of oculocardiac reflex and subsequent pulmonary edema in a patient with extraocular cysticercosis

Ghai, Babita; Makkar, Jeetinder Kaur; Arora, Saurabh

doi:10.1111/j.1460-9592.2006.01972.x

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Several authors have written more than once regarding oculocardiac reflex. Two papers were written by Kirsch, 18 , 34 Fessl-Alemany, 106 , 233 Apivor and Ravi, 36 , 234 Ge, 235 , 236 Ghai, 10 , 144 Klockgether-Radke, 65 , 133 Tramér, 77 , 91 Grover, 50 , 237 Paciuc, 82 , 172 and Mirakhur. 70 , 126 Fry wrote three papers.…”

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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Section: Influence Of Anesthesiologistmentioning

confidence: 99%

“… 9 Asystole and pulmonary edema have been reported associated with infestation of an extraocular muscle. 10 Myocardial infarction has been reported associated with OCR treatment. 11 Death during strabismus surgery appears to be rare.…”

Section: Introductionmentioning

confidence: 99%

The Oculocardiac Reflex: A Review

Arnold¹

2021

OPTH

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“… 1 , 5 – 7 In most cases, the OCR resolves without treatment, but some patients develop cardiac arrest and, in very rare cases, sudden death. 8 , 9 The OCR occurs more often in pediatric patients and in those undergoing surgery on the medial rectus (MR) muscle; however, it is less prevalent in pediatric patients when deeper anesthesia is induced. 5 , 7 , 10 – 12 …”

Section: Introductionmentioning

confidence: 99%

Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study

2020

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Objective To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration. Methods The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed. Results The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively). Conclusions The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.

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Setting up a heart rate alarm limit to decrease oculocardiac reflex during strabismus surgery in children

Zhang

2008

Front. Med. China

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The aim of this paper is to investigate a method which may decrease the incidence and severity of oculocardiac reflex (OCR) without drugs. One hundred and sixty children undergoing strabismus surgery were allocated to two groups using double-blind randomization. OCR was defined as a decrease of more than 10% from the baseline heart rate during operation. An alarm sounded and a lamp flashed as soon as OCR occurred in group I, and neither of the above happened in group II. OCR occurred (1.151 ¡ 0.858) times in group I and (2.287 ¡ 1.371) times in group II (P , 0.05). Heart rate decreased by (23 ¡ 19) bpm in group I and (35 ¡ 28) bpm in group II (P , 0.05). The duration of OCR in group I and group II was (4.36 ¡ 4.26)s and (7.62 ¡ 6.41)s, respectively (P , 0.05). The recovery time for group I and group II was (15.36 ¡ 13.28)s and (32.36 ¡ 19.57)s, respectively (P , 0.05). The numbers of times of interruption were 8 in group I (10%) and 26 in group II (32%) (P , 0.01). This method significantly decreased the incidence and severity of OCR during strabismus surgery in children.

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Intraoperative cardiac arrest because of oculocardiac reflex and subsequent pulmonary edema in a patient with extraocular cysticercosis

Cited by 6 publications

References 6 publications

The Oculocardiac Reflex: A Review

The Oculocardiac Reflex: A Review

Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study

Setting up a heart rate alarm limit to decrease oculocardiac reflex during strabismus surgery in children

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