The Oculocardiac Reflex in Strabismus Surgery

Apt, Leonard; Isenberg, Sherwin J.; Gaffney, William L.

doi:10.1016/0002-9394(73)90743-5

Cited by 72 publications

(43 citation statements)

References 6 publications

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“…8,9,[13][14][15] The OCR may also be induced by pressure on the corneal surface of the eye, traction of an EOM, hematoma, ocular trauma, or the activation of corneal nociceptors. 8,9,[13][14][15] The OCR may also be induced by pressure on the corneal surface of the eye, traction of an EOM, hematoma, ocular trauma, or the activation of corneal nociceptors.…”

Section: Mechanismmentioning

confidence: 99%

The Oculocardiac Reflex

Bharati

Chowdhury

2015

Trigeminocardiac Reflex

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Section: Mechanismmentioning

confidence: 99%

The Oculocardiac Reflex

Bharati

Chowdhury

2015

Trigeminocardiac Reflex

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“…[2] Epidemiology of the Trigeminocardiac Reflex It has been demonstrated that the TCR may occur with manipulation of all the branches of the trigeminal nerve anywhere along its (intracranial or extracranial) course. [7,8,[12][13][14][15][16] The OCR, which is a subvariant of the TCR, and studied far earlier, was said to occur in up to 67% of the patients operated for strabismus, [17] but a lot of authors only studied the heart rate and a reduction in heart rate by 10% or more was taken as a positive OCR, so that the real incidence may be substantially smaller. According to Schaller's experience, the TCR occurs in 10-18% of the patients.…”

Section: Introductionmentioning

confidence: 99%

Management of the trigeminocardiac reflex: Facts and own experience

et al. 2009

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The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during stimulation of any of the sensory branches of the trigeminal nerve. The proposed mechanism for the development of TCR is--the sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. It has been demonstrated that the TCR may occur with mechanical stimulation of all the branches of the trigeminal nerve anywhere along its course (central or peripheral). The reaction subsides with cessation of the stimulus. But, some patients may develop severe bradycardia, asystole, and arterial hypotension which require intervention. The risk factors already known to increase the incidence of TCR include: Hypercapnia; hypoxemia; light general anesthesia; age (more pronounced in children); the nature of the provoking stimulus (stimulus strength and duration); and drugs: Potent narcotic agents (sufentanil and alfentanil); beta-blockers; and calcium channel blockers. Because of the lack of full understanding of the TCR physiology, the current treatment options for patients with TCR include: (i) risk factor identification and modification; (ii) prophylactic measures; and (iii) administration of vagolytic agents or sympathomimetics.

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“…[12][13][14][15][16][17][18][19][20] Similarly, the oculocardiac reflex is reported to occur in ~17% of patients undergoing surgery for strabismus. 21 During neurosurgical procedures, abrupt and sustained traction of structures innervated by the trigeminal nerve is more prone to elicit the TCR than smooth and gentle traction. Note that these estimates may underreport the true incidence, because many minor decrements in heart rate or blood pressure in response to manipulation of trigeminal branches may not be remarked upon by anesthesiologists and surgeons involved in such procedures.…”

Section: Introductionmentioning

confidence: 99%