Prevention of the Oculo-Cardiac Reflex in Children Comparison of Retrobulbar Block and Intravenous Atropine

The Oculocardiac Reflex

“…Acute and sustained stimulation of EOMs is more reflexogenic than transient, gentle, and gradual traction. [24][25][26][27][28][29][30][31][32] The OCR can be managed by releasing ocular pressure, increasing anesthetic depth, and/ or using rescue atropine. Activation of the reflex, as well as the accessibility of the EOM muscle and the pressure required for its exposure, is more dependent on the ocular pathology and technique of surgery.…”

“…Accordingly, one of the important preventive measure is to avoid aggressive manipulation of the EOMs, whose causal role in the occurrence of the OCR is still controversial. [24][25][26][27][28][29][30] Anticholinergic prophylaxis has also been found to decrease the incidence of the OCR. 13,14 Pretreatment with anticholinergic and regional anesthesia techniques have proven to be of benefit in preventing intraoperative episodes of the OCR.…”

“…Activation of the reflex, as well as the accessibility of the EOM muscle and the pressure required for its exposure, is more dependent on the ocular pathology and technique of surgery. [24][25][26][27][28] Using anticholinergics as a preventative is a logical option in high-risk cases. [24][25][26][27][28][29] The incidence of bradycardia was reduced from 70% to 10% in strabismus surgery in patients following pretreatment with IV atropine.…”

“…13,14 Pretreatment with anticholinergic and regional anesthesia techniques have proven to be of benefit in preventing intraoperative episodes of the OCR. [24][25][26][27][28] A pertinent question regarding the use of prophylactic anticholinergics is their route of administration. Because atropine may lead to more dangerous arrhythmias than the OCR itself, prophylaxis is typically reserved for pediatric patients.…”

Regional anaesthesia for intraocular surgery

“…The incidence of cardiac arrhythmias due to oculocardiac reflex during eye surgery is as high as 58% to 82%. 176,177 Strabismus surgery in children tends to be associated with a high incidence of this complication. Anticholinergic drugs such as atropine or glycopyrrolate are commonly used as prophylaxis against this complication, but have not been consistently effective.…”