ANTICHOLINERGIC PREMEDICATION FOR PREVENTION OF OCULOCARDIAC REFLEX DURING SQUINT SURGERY

Syed Mushtaq Gilani, Muhammad Jamil, Farhat Akbar, Roomana Jehangir

Abstract


Background: Profound bradycardia during eye surgery is potentially serious event. In clinical
practice this Oculocardiac Reflex (OCR) is most often encountered during squint surgery. The
objective of this study was to assess the occurrence of OCR and prove the effect of anticholinergic
premedication (atropine) to prevent OCR. Methods: This study comprises of sixty patients (age 2-
30 years) operated for squint surgery under general anaesthesia. Cases were divided into two
groups of thirty each. Group 1 was premedicated with intravenous injection of atropine and Group
2 did not receive any premedication. Patients were monitored during operation for any bradycardia
or dysrhythmias. Results: The observed data showed occurrence of 70% OCR in Group 2 as
compared to only 10% in Group 1. Severe bradycardia in 40% cases of Group 2 needed
intervention by IV injection of atropine. Conclusion: Our study showed that atropine
premedication in the patients of squint surgery under general anaesthesia definitely obtunds OCR
and prevents any untoward effects of dysrhythmias during eye surgery.
Keywords: Oculocardiac Relex (OCR), squint surgery, atropine premedication

Full Text:

PDF

References


Gandevia SC, McCloskey DI, Potter EK. Reflex

bradycardia occurring in response to diving,

nasopharyngeal stimulation, and ocular pressure. J

Physiol 1978;276:383-94

Hunsley JE, Bush GH, Jones CJ. “A study of

glycopyrolate and atropine in suppression of

oculocardiac reflex during strabismus surgery in

children B J A 1982;54(4)459-64.

Seok, Takayama H, Araya Y, Miura K, Someya G. A

case of sinus arrest caused by opening the mouth under

general anesthesia.” Anesth Prog 1994;41(1):17-8

Smith RB. Death and the oculocardiac reflex. Can J

Anaesth. 1994 Aug; 41(8):760

Campbell R, Rodrigo D, Cheung L. Asystole and

bradycardia during maxillofacial surgery. Anesth Prog,

:41(1)13-6

Lang SA, VanderWal M. Death from OCR. Canad J

Anaesth 1994;41(2):161

Watcha MF, Simeon RM, White PF, Stevens JL. Effect

of Propofal on the incidence of post operative vomiting

after strabismus surgery in Paediatric outpatients

Anesthesiology 1991;75(2):204-9

Tramer MR, Sansonett A, Fuchs-Buder T, Rifat K.

Oculocardiac Reflex and postoperative vomiting in

paediatric strabismus surgery. A randomised controlled

trial. Acta Anaesthesiol Scand 1998;42(1):117-23.

Hahnenkamp K, Honemann CW, Fischer LG, Durieux

ME, Muehlendyck H, Braun U. Effect of different

anaesthetic regimes on the oculocardiac reflex during

paediatric strabismus surgery. Paediatr Anaesth 2000;

(6):601-8.

Allison CE, De Lange JJ, Koole FD, Zuurmond WW,

Ros HH, van Schagen NT. A comparison of the

incidence of the oculocardiac and oculorespiratory

reflexes during sevoflurane or halothane anesthesia for

strabismus surgery in children. Anesth Analg 2000;

(2):306-10

Karanovic N, Jukic M, Carev M, Kardum G, Dogas Z.

Rocuronium attenuates oculocardiac reflex during

squint surgery in children anesthetized with halothane

and nitrous oxide. Acta Anaesthesiol Scand

;48(10):1301-5

Grover VK, Bhardwaj N, Shobana N, Grewal SP.

Oculo cardiac reflex during retinal surgery using

peribulbar block and nitrous oxide narcotic anaesthesia.

Ophthalmic Surg Lasers 1998;29(3):207-12

Anez C, Rodsiguez PA Morales F, Partida-C. Cardiac

Trigeminal reflex during compression of gasserain

ganglion. Rev Esp Anasthesiol Reanim 1994;41(1):42-3

Munden PM, Carter KD, Nerad JA. Oculocardiac reflex

during enucleation (letter). Am J Opthalmol

;111(3):378-9

Arnold R. Oculocardiac reflex caused by contact lenses.

(author reply). Ophthalmic Physiol Opt

;23(6):571-2.

Locke MM, Spiekermann BF, Rich GF.

Trigeminovagal reflex during repair of a nasal fracture

under general anesthesia. Anesth Analg. 1999 May;

(5):1183-4.

Karhunen U, Cozanitis DA Brander P. The

oculocardiac reflex in adults. A dose response study of

glycopyrrolate and atropine. Anaesthesia 1984;

(6):524-8.

Chisakuta AM, Mirakhur RK. Anticholinergic

prophylaxis does not prevent emesis following

strabismus surgery in children. Paediatr Anaesth

;5(2) 97-100.

Arnold RW, Farah RF, Monroe G. The attenuating

effect of intraglossal atropine on the oculocardiac

reflex. Binocul Vis Strabismus Q 2002;17(4):313-8.

Arnold RW, Gould AB, Mackenzie R, Dyer JA, Low

PA. Lack of Global Vagal propensity in patients of

OCR. Ophthamology 1994;101 (8):1347-52

Dornberger I, Quast D, Velhagen KH. Oculocardiac

reflex during vitrectomy under neuroleptanalgesia.

Anaesthesiol Reanim 1991;16(2):94-106

Yu-Xm, Wang LH. Oculocardiac reflex during ocular

operation under various anaesthesia. Chung-Hua-YenKo-Tsa-Chih 1991;27(1):34-6

Deb K, Subramaniam R, Dehran M, Tandon R, Shende

D. Safety and efficacy of peribulbar block as adjunct to

general anaesthesia for paediatric ophthalmic surgery.

Paediatr Anaesth. 2001;11(2):161-7.

Ruta U, Mollhoff T, Markodimitrakis H, Brodner G.

Attenuation of Oculo cardiac reflex after topically

applied lignocain during surgery for strabismus in

children. Eur J Anaesthesiol 1996;13(1):11-5.

Mirakhur RK, Shepherd WF, Jones CJ. Ventilation and

the oculocardiac reflex. Prevention of oculocardiac

reflex during surgery for squints: role of controlled

ventilation and anticholinergic drugs. Anaesthesia

;41(8):825-8.

Wilhelm S, Standl T, Does Propofol have advantage

over isoflurane for sufentanil supplemented anaesthesia

in children for strabismus surgery. Anaesthesiol

Intensive med 1991;31(7):414-9

Tramer M, Moore A, Mc Quay H. Prevention of

vomiting after paediatric strabismus surgery- A

systemic review. Brit J Anaesth 1995;75(5):556-61

Loewinger J, Friedmann NI, Cohen M, Levi E. Effect

of atracurium and pancuronium on Oculo cardiac reflex

in children. Anesth Analg 1991;73(1):25-8


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]