ANTICHOLINERGIC PREMEDICATION FOR PREVENTION OF OCULOCARDIAC REFLEX DURING SQUINT SURGERY
AbstractBackground: Profound bradycardia during eye surgery is potentially serious event. In clinicalpractice this Oculocardiac Reflex (OCR) is most often encountered during squint surgery. Theobjective of this study was to assess the occurrence of OCR and prove the effect of anticholinergicpremedication (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 twogroups of thirty each. Group 1 was premedicated with intravenous injection of atropine and Group2 did not receive any premedication. Patients were monitored during operation for any bradycardiaor dysrhythmias. Results: The observed data showed occurrence of 70% OCR in Group 2 ascompared to only 10% in Group 1. Severe bradycardia in 40% cases of Group 2 neededintervention by IV injection of atropine. Conclusion: Our study showed that atropinepremedication in the patients of squint surgery under general anaesthesia definitely obtunds OCRand prevents any untoward effects of dysrhythmias during eye surgery.Keywords: Oculocardiac Relex (OCR), squint surgery, atropine premedication
Gandevia SC, McCloskey DI, Potter EK. Reflex
bradycardia occurring in response to diving,
nasopharyngeal stimulation, and ocular pressure. J
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,
Lang SA, VanderWal M. Death from OCR. Canad J
Watcha MF, Simeon RM, White PF, Stevens JL. Effect
of Propofal on the incidence of post operative vomiting
after strabismus surgery in Paediatric outpatients
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;
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;
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
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
Arnold R. Oculocardiac reflex caused by contact lenses.
(author reply). Ophthalmic Physiol Opt
Locke MM, Spiekermann BF, Rich GF.
Trigeminovagal reflex during repair of a nasal fracture
under general anesthesia. Anesth Analg. 1999 May;
Karhunen U, Cozanitis DA Brander P. The
oculocardiac reflex in adults. A dose response study of
glycopyrrolate and atropine. Anaesthesia 1984;
Chisakuta AM, Mirakhur RK. Anticholinergic
prophylaxis does not prevent emesis following
strabismus surgery in children. Paediatr Anaesth
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
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