Oculocardiac Reflex during Strabismus Surgery: Experience from a Tertiary Hospital

Aletaha, Maryam; Bagheri, Abbas; Roodneshin, Fatemeh; Mosallaei, Mahnaz; Yazdani, Shahin

doi:10.3109/09273972.2016.1170049

Cited by 18 publications

(20 citation statements)

References 17 publications

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“…So, it is essential to accurately control the heart rate during ophthalmic surgeries [13]. Different modalities of treatments have been investigated to prevent or alleviate OCR with conflicting findings [27]. This was considered in our study, and it was observed that magnesium sulphate addition completely inhibited the occurrence of OCR reflex.…”

Section: Discussionmentioning

confidence: 81%

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

Sherif¹,

Mohamad²,

Taher³

et al. 2019

TOATJ

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Background: Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia. Objective: The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery. Methods: A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data. Results: The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001). Conclusion: Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

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Section: Discussionmentioning

confidence: 81%

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

Sherif¹,

Mohamad²,

Taher³

et al. 2019

TOATJ

View full text Add to dashboard Cite

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“…Retrobulbar block, premedication with anticholinergics, and gentle tension of muscle traction have been suggested to reduce the rate of OCR [11,15,16]. OCR is known to occur more frequently during MR surgery than during LR surgery, due to differences in the afferent pathways involved; it occurs less frequently under deeper anesthesia [5,7,11,12,17]. In our study, LR and MR did not show differences in the incidence of OCR, in either pediatric or adult patients; moreover, changes in HR during muscle traction were not associated with the depth of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…The OCR is defined as a 10-20% reduction in heart rate (HR) from the baseline value or dysrhythmia [1,2,4]. The incidence of OCR ranged from 14% to 90% in previously published studies, depending on the definition used [1,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Most cases of OCR resolve without treatment, but some patients exhibit cardiac arrest and, in very rare cases, sudden death [8,9]. The OCR is known to occur more often in pediatric patients, and in those undergoing surgery on medial rectus (MR) muscles, but it is less prevalent in pediatric patients when deeper anesthesia is induced [5,7,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Oculocardiac and Oculorespiratory Reflex during Strabismus Surgery under General Anesthesia with Laryngeal Mask Airway for Maintaining Spontaneous Respiration: A Retrospective Study

Shin

Kim

Joo

2019

Preprint

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Background: The oculocardiac reflex (OCR) is defined as a 10–20% reduction in heart rate (HR) from the baseline value or dysrhythmia, and the oculorespiratory reflex (ORR) manifests as shallow respiratory movement and bradypnea caused by manipulation of the eye. The aim of this study was to elucidate whether the specific muscle operated on has an effect on OCR and ORR, as well as whether the depth of anesthesia influences the OCR and ORR in patients undergoing strabismus surgery with laryngeal mask airway (LMA) to maintain spontaneous respiration. Methods: The medical records of patients who underwent strabismus surgery on lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were reviewed. For anesthesia induction, propofol was administered and the LMA was inserted. Anesthesia was maintained with sevoflurane and spontaneous respiration. Results: The incidences of OCR during LR and MR operations were not significantly different between pediatric and adult patients (29% vs 27% and 15% vs 16%, respectively, p < 0.05). The incidence of ORR, as indexed by tidal volume (TV), was higher during MR surgery than during LR surgery in pediatric patients (29.3% vs 10.1%, p < 0.05). The change in HR during muscle traction and bispectral index (BIS) showed a negative correlation in pediatric patients, but this was not statistically significant. The change in TV during muscle traction and BIS was significantly correlated, in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively, p < 0.05), while the change in respiratory rate (RR) during muscle traction and BIS did not show a significant correlation in either group. Conclusions: The incidence rate of OCR did not differ between LR and MR surgeries, and the depth of anesthesia did not correlate with HR changes during muscle traction. Young age and MR surgery may be risk factors for ORR. However, MV did not decrease because of the increased RR during muscle traction. Thus, maintenance of spontaneous respiration with an LMA is safe during strabismus surgery under general anesthesia for both pediatric and adult patients.

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“… 1 , 2 , 4 The incidence of the OCR ranges from 14% to 90% in previously published studies depending on the definition used. 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.…”

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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Oculocardiac Reflex during Strabismus Surgery: Experience from a Tertiary Hospital

Cited by 18 publications

References 17 publications

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

Oculocardiac and Oculorespiratory Reflex during Strabismus Surgery under General Anesthesia with Laryngeal Mask Airway for Maintaining Spontaneous Respiration: A Retrospective Study

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

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