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At least 19 recordsLinked to original sources
PubMed1986

Ventilation and the oculocardiac reflex. Prevention of oculocardiac reflex during surgery for squints: role of controlled ventilation and anticholinergic drugs.

A randomised prospective study was carried out in children undergoing surgery for squint correction, to determine the value of controlled ventilation as a prophylaxis against the occurrence of the oculocardiac reflex. One hundred patients anaesthetised with nitrous oxide/oxygen and halothane were randomly assigned to either ventilated or spontaneously breathing groups of 50 each. Half the patients in each group received glycopyrronium 7.5 micrograms/kg intravenously at the time of induction of anaesthesia. Heart rate, rhythm, blood pressure and end tidal CO2 concentration were monitored throughout. A positive oculocardiac reflex, defined as a fall in heart rate of 20% or more and/or the occurrence of dysrhythmias, was observed in 72% of spontaneously breathing patients and in 100% of ventilated patients not receiving prophylactic intravenous glycopyrronium. The incidence of a positive reflex in patients receiving glycopyrronium was 10% (4 and 16% respectively in spontaneously breathing and ventilated patients). It is concluded that controlled ventilation is of no value as a preventive measure against the occurrence of the oculocardiac reflex in patients undergoing squint surgery and that prophylaxis is safely achieved with the use of intravenous glycopyrronium.

Adolescent↗
PubMed1997

[Effect of locally applied lidocaine on expression of the oculocardiac reflex].

INTRODUCTION: The oculocardiac reflex causes severe bradycardic arrhythmias and is a frequent complication during surgical manipulation at the medial rectus muscle. The purpose of this study was to evaluate the influence of lidocaine administered topically on the muscle on the incidence of the oculocardiac reflex. PATIENTS AND METHODS: After obtaining informed consent, 140 patients with strabism or retinal surgery were included in this study. All patients received standard premedication and anesthesia and were randomly assigned to two groups. Patients (n = 70) randomly assigned to the first group received 1 mg/kg lidocaine applied topically to the muscle after opening the conjunctiva. Individuals in the placebo group received the same volume of saline (0.9%). Surgical stimulation occurred 5 min after administration of the drug. The study parameters (blood pressure/heart rate) were recorded before and after stimulation of the oculocardiac reflex caused by routine surgical preparation. RESULTS: Topical administration of lidocaine reduced the incidence of the oculocardiac reflex (86.1% vs 37.1%), and the frequency of severe bradycardiac arrhythmias was also significantly reduced (40 vs. 2.9%). Cardiac arrest for longer than 10 s did not occur in the lidocaine group. In the control group this phenomenon was observed in 14.8%.

Adolescent↗
PubMed1983

Diving bradycardia is not correlated to the oculocardiac reflex.

Both facial immersion in cold water and pressure on the eyeball cause reflex bradycardia. These reflexes are called diving reflex and oculocardiac reflex, respectively. The latter is sometimes used in diving medicine to estimate the risk of severe diving bradycardia. The purpose of this study was to quantify the effects of both reflexes on heart rate in 15 subjects. All subjects performed four tests: (1) breath-holding (2) breath-holding and facial immersion in water of 10 degrees, 15 degrees, and 20 degrees C; (3) facial immersion in water and snorkeling; (4) application of pressure of 30, 50, and 70 mmHg on the eyeball. In seven subjects an additional test was done: (5) eyeball pressures during breath-holding. It was shown that the intensity of the oculocardiac reflex is not a good indication of the bradycardia that can be expected during diving. It is proposed that breath-holding with facial immersion in water of 20 degrees C or colder during at least 10 s is a more appropriate test to assess the possibility of severe diving bradycardia and cardiac arrhythmias.

Adult↗
PubMed1989

The oculocardiac reflex in blepharoplasty surgery.

The oculocardiac reflex (OCR), a previously undescribed phenomenon in aesthetic blepharoplasty surgery, involves intraoperative bradycardia exceeding 10 percent of the preoperative heart rate or any dysrhythmia during ocular manipulation. It is a trigeminal-vagal-mediated reflex arc. The oculocardiac reflex was noted to occur in 25 of 100 patients (25 percent) undergoing blepharoplasty. A data sheet designed and distributed for use in the operating room identified a reflex-prone patient (RPP) as a young, anxious female, with a cardiac history, operated on under light anesthesia with aggressive fat pad resection. The oculocardiac reflex was more likely to occur in a reflex-prone patient during traction on the medial fat pads and in the left eye. Despite anticipating the fatigue phenomenon in those patients who exhibited a profound bradycardia (35 to 40 beats per minute), it was necessary to release traction in order to permit the heart rate to return to normal. Awareness and treatment of this potentially life-threatening oculocardiac reflex are necessary. Careful patient surveillance and monitoring are mandatory.

Adult↗
PubMed1986

Oculocardiac reflex and the anesthesiologist.

Oculocardiac reflex is one of the trigemino-vagal reflexes, and is frequently observed during anesthesia for pediatric strabismus surgery. The reflex is greatly exaggerated in the presence of hypoventilation, hypoxemia and acidosis. The reflex is important as a cause of cardiac arrest during eye surgery. Several related reflexes are known, such as blepharocardiac reflex, oculorespiratory reflex, and the sudden infant death syndrome. Although the reflex can be prevented by a retrobulbar block or the administration of parasympatholytic drugs, well conducted anesthesia and cooperation with the surgeon is much more important.

Anesthesia, General↗
PubMed1982

The oculocardiac reflex: a review.

The oculocardiac reflex (OCR), which may result from traction or pressure on the globe, orbital contents, or extra ocular muscles, has been associated with cardiac arrests during ocular surgery. The pathways for this reflex have been established and several preventive methods including retrobulbar block and intravenous injection of atropine have been developed. These procedures, combined with recent advances in anesthesia, may have reduced the occurrence of fatal cardiac arrests caused by the elicitation of the reflex during ocular surgery, however, for numerous reasons, the reflex remains of optometric interest.

Animals↗
PubMed1991

Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex.

Three case reports are presented to illustrate the existence and importance of reflex bradycardic responses that can occur during maxillofacial surgical procedures. All three patients were healthy young adults undergoing operations which did not include any manipulation of orbital structures. After the patients had been anaesthetized for some time and were haemodynamically stable, profound bradycardia or ventricular asystole occurred suddenly in response to manipulations of the bony structures of the maxilla or mandible, or dissection of, or traction on, the attached soft tissue structures. The parasympathetic supply to the face is carried in the trigeminal nerve. Alternative afferent pathways must exist via the maxillary and/or mandibular divisions, in addition to the commonly reported pathway via the ophthalmic division of the trigeminal nerve in the classic oculocardiac reflex. The efferent arc involves the vagus, regardless of which branch of the trigeminal nerve transmits the afferent impulses. All patients undergoing maxillofacial procedures should be monitored carefully for reflex bradycardia and ventricular asystole.

Adult↗
PubMed1991

[The oculocardiac reflex during vitrectomy under neuroleptanalgesia].

Oculocardiac reflex (OCR) is a frequently occurring complication in eye operations. It is a trigemino-vagal reflex characterised by the clinical occurrence of bradycardia and other cardiac rhythm disturbances following manipulations on the eye and its surroundings especially after traction of the external eye muscles. In this paper based on an analysis of 402 anaesthesia records, a bradycardia frequency (f = less than 60/min) of 31.8% was noted while other rhythm disturbances occurred in 5.7%. Predisposition facts were identified as age over 50, hypertension and cardiac diseases requiring medication with cardiac drugs. The frequency of OCR is considerably lowered by diabetes mellitus. Examination of 159 traction measurements made at the lateral rectus muscle revealed that the first manipulation made at the rectus bulbi superior muscle resulted in a statistically significantly stronger reflex activity than at the other muscles. In a further series of investigations in which rectus bulbi superior muscle was tested last, this muscle again showed the biggest frequency deviation. Only determination of the percentage heart rate decrease is suitable for characterising reflex activity. The frequency of the reflex occurring in our study was 71.7%, the result being reduced by the high proportion of diabetics, who are relatively reflex insensitive.

Adolescent↗
PubMed1980

The oculocardiac reflex as a surgical aid in identifying a slipped or 'lost' extraocular muscle.

The oculocardiac reflex during strabismus surgery has generally been regarded as a hazard capable of causing death. Six cases are presented which show a beneficial use of the oculocardiac reflex. Isolation of a previously slipped or 'lost' extraocular muscle can be difficult. In this series identification of the tissue as muscle was substantiated by observing a positive oculocardiac reflex when traction was placed on the suspected tissue. Each of the 6 dislodged extraocular muscles was the medial rectus muscle. Three of the muscles had been resected and 3 either recessed or tenotomised. In one patient, despite 6 previous strabismus operations, including 2 strabotomies on a muscle that slipped, and in another patient, who had a lapse of 6 years since the last strabotomy, when the slipped muscle was isolated, the oculocardiac reflex could still be elicited. To avoid abolishing the oculocardiac reflex during surgery the anaesthetist should be instructed to avoid the use of an intravenous parasympatholytic agent, such as atropine, at the time of induction and during the operation.

Adult↗
PubMed1997

[Oculocardiac reflex in senile cataract operation].

OBJECTIVE: To determine the incidence of the oculocardiac reflex and to identify which steps in the process in senile cataract operation are more important in eliciting the reflex. METHODS: Dynamic electrocardiogram was recorded with a 24 hour Holter's monitoring at the time of following steps: preoperation, retrobulbar anesthesia, softening of eyeball, superior rectus suture, corneoscleral incision, delivery of the nucleus and posterior chamber lens implantation. Oculocardiac reflex was defined as at least a 10% decrease in heart rate below relative baseline. RESULTS: 14 times of oculocardiac reflex occurred in 10 of 30 patients (33.3%). All maneuvers except for superior rectus fixation triggered the reflex in our group. In addition, premature beat was noted in 5 patients. CONCLUSION: Our patients indicate that cataract extraction may result in abnormalities in both heart rate and rhythm. The definition of the oculocardiac reflex may be too conservative and requires redefinition.

Aged↗
PubMed2000

Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery.

The oculocardiac reflex (OCR) is induced by mechanical stimulation and therefore is frequently encountered during strabismus surgery. This study was designed to determine how various anaesthetic regimes modulate the haemodynamic effects of the OCR during paediatric strabismus surgery. Thirty-nine patients (4-14 years, ASA I) were randomized to one of four anaesthetic regimes: group P: propofol (12 mg.kg(-1).h(-1)) and alfentanil (0.04 mg.kg(-1).h(-1)); group S: sevoflurane 1-1.2 MAC in 30% O(2)/70% N(2)O; group K: ketamine racemate (10-12 mg. kg(-1).h(-1)) and midazolam (0.3-0.6 mg.kg(-1).h(-1); group H: halothane 1-1. 2 MAC in 30% O(2)/70% N(2)O. Electrocardiogram (ECG), beat-to-beat heart rate (HR) and blood pressure (BP) changes were measured during and after a standardized traction was applied to an external eye muscle (4-6 Newton, 90 s). OCR was defined as a 10% change in HR induced by traction. OCR occurred in 77% of patients. Whereas virtually all patients in the P, H and S groups developed OCR, only 22% developed it in group K. Median HR change in group P (-37 bpm) was significantly greater (P < 0.05) than in group H (-17 bpm) or group K (-7 bpm). Median BP change in group K (+10 mmHg) was significantly different (P < 0.05) from group H (-5 mmHg), group S (-3 mmHg) and group P (-8 mmHg). Atrioventricular rhythm disorders were significantly more frequent in group P compared with group K (P < 0.02). Respiration-induced sinus dysrhythmia was significantly less frequent (P < 0.001) in group K (0%), compared with group P (100%), group H (56%) and group S (55%). Of the anaesthetic techniques studied, ketamine anaesthesia is associated with the least haemodynamic changes induced by OCR during strabismus surgery in paediatric patients.

Adolescent↗
PubMed1992

Oculocardiac reflex in the anophthalmic socket.

The oculocardiac reflex occurred in a patient with an anophthalmic socket undergoing surgery for inferior fornix shortening and laxity of the lower lid. This reflex occurs only rarely in anophthalmia; it has not been previously reported during socket surgery.

Aged↗
PubMed2000

Oculocardiac reflex induced by zygomatic fracture; a case report.

Oculocardiac reflex has been recognized as the result of mechanical stimulation to the orbital tissue. The authors encountered a case of severe arrhythmia due to oculocardiac reflex in a patient with a zygomatic fracture. Previous health examinations suggested no abnormalities in the heart in his schooldays, and the initial diagnosis of his arrhythmia as complete A-V block due to injury (using ECG and cardiac ultrasonography). Because his arrhythmia did not improve spontaneously, he underwent cardiac pacing. After repair of the fracture, his arrhythmia completely disappeared. The pacemaker was removed on the first postoperative day. The pathogenesis of this rare case will be discussed.

Adult↗
PubMed1999

Elicitation of the oculocardiac reflex during endoscopic forehead lift surgery.

Elicitation of the oculocardiac reflex is a well-documented phenomenon encountered during ophthalmologic surgical procedures. Familiarity with and prompt recognition of this entity has significantly reduced the morbidity associated with it; however, potentially lethal arrhythmias and cardiac arrest still occur. We report elicitation of the reflex during manipulation of the supraorbital nerve during endoscopic forehead lift surgery. To our knowledge this is the first case of elicitation of the oculocardiac reflex reported during endoscopic forehead lift surgery.

Bradycardia↗
PubMed1999

Iris color alone does not predict susceptibility to the oculocardiac reflex in strabismus surgery.

PURPOSE: To test prior published observations that patients with brown irides were more susceptible to the oculocardiac reflex. SUBJECTS AND METHODS: 466 adults and children underwent surgery on an extraocular muscle under general anesthesia without anticholinergic blockade. The first rectus muscle isolated was given a predetermined specific force pull during electrocardiograph monitoring. Iris color was retrieved from the deliberate clinical charting. RESULTS: The occurrence of the oculocardiac reflex did not correlate with age, but did profoundly for the inferior rectus and least for the lateral rectus. Iris color did not influence the incidence of occurrence of moderate or severe oculocardiac reflex. CONCLUSION: The prediction of oculocardiac reflex propensity remains elusive.

Adolescent↗