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Cureus Apr 2019The 'white-eyed' blowout fracture (WEBOF) is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features.... (Review)
Review
The 'white-eyed' blowout fracture (WEBOF) is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features. Although benign in appearance, it can lead to significant patient morbidity. Here, we intend to increase the awareness of WEBOF and provide general principles for its diagnosis. WEBOF should be recognized early to ensure timely management and a successful outcome.
PubMed: 31245200
DOI: 10.7759/cureus.4412 -
Cureus May 2024Oculocardiac reflex (OCR), presenting as bradycardia and asystole, is a potential intraoperative complication that may occur during maxillofacial trauma surgery....
Oculocardiac reflex (OCR), presenting as bradycardia and asystole, is a potential intraoperative complication that may occur during maxillofacial trauma surgery. Bradycardia is the most common symptom of this phenomenon. Surgeons should be aware of its long-term effects, such as arrhythmias and even cardiac arrest. We report the case of a 40-year-old male patient with a fracture of the floor of the orbit. During a surgical exploration of the orbital floor, the patient exhibited sudden symptoms of OCR. It was managed by withholding the surgery and administering atropine. The article also highlights the mechanism, types, incidence, and management of OCR in patients with maxillofacial trauma.
PubMed: 38827001
DOI: 10.7759/cureus.59528 -
BMC Anesthesiology Feb 2021Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used... (Randomized Controlled Trial)
Randomized Controlled Trial
Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison.
BACKGROUND
Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery.
METHODS
In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded.
RESULTS
Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P < 0.01) and mitigated PONV severity as indicated by severity scoring (P < 0.01). Compared with normal saline, penehyclidine also significantly reduced OCR incidence (57.9% vs. 77.9%, P < 0.01) and mitigated OCR severity, as indicated by the requirement for atropine rescue (77.3% vs. 90.1%, P < 0.05) and the maximum decrease of heart rate during OCR (23.1 ± 9.4 bpm vs. 27.3 ± 12.4 bpm, P < 0.05). The recovery course did not differ between groups.
CONCLUSIONS
Penehyclidine administrated after anesthesia induction significantly reduced the incidence of PONV and alleviated intraoperative OCR in patients undergoing strabismus surgery.
TRIAL REGISTRATION
ClinicalTrials.gov ( NCT04054479 ). Retrospectively registered August 13, 2019.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Double-Blind Method; Female; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Nausea and Vomiting; Quinuclidines; Reflex, Oculocardiac; Strabismus; Young Adult
PubMed: 33581727
DOI: 10.1186/s12871-021-01266-0 -
Frontiers in Pediatrics 2023The effect of post-operation sub-Tenon's bupivacaine injection for pediatric strabismus surgery is controversial. The objective of this meta-analysis is to compare the... (Review)
Review
BACKGROUND
The effect of post-operation sub-Tenon's bupivacaine injection for pediatric strabismus surgery is controversial. The objective of this meta-analysis is to compare the outcome of sub-Tenon injection of bupivacaine and placebo duringstrabismus surgery.
METHODS
We searched the databases (Pubmed, Cochrane library and EMBASE) and reference lists systematically. Randomized controlled trials (RCTs) comparing sub-Tenon's bupivacaine and placebo injection for pediatric strabismus surgery were included. The methodological quality was evaluated by the Cochrane risk of bias (ROB) tool. Outcome measurements were pain score, oculocardiac reflex (OCR), additional drug consumption and related complications. RevMan 5.4 was used for the statistical analysis and graph preparation. For the outcomes that are not suitable for statistical analysis, descriptive analysis was performed.
RESULTS
A total of 5 RCTs with 217 patients were finally identified and analyzed. Sub-Tenon's bupivacaine injection showed pain relief within 30 min after operation. But with the extension of time, the analgesic effect gradually disappeared at 1 h. It can reduce the incidence of OCR, vomiting and supplementary drug requirements. However, in terms of nausea, there is no difference between the two groups.
CONCLUSION
Sub-Tenon's bupivacaine injection can relieve short-term postoperative pain, reduce the incidence of OCR and vomiting, and reduce the use of supplementary drugs in strabismus surgery.
PubMed: 36873651
DOI: 10.3389/fped.2023.1105186 -
Strabismus Mar 2019Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The present study evaluated the effects of Tetracaine eye drop as a topical nerve blocker on OCR during strabismus surgery.
METHODS AND MATERIALS
In this randomized trial, 70 strabismus surgery candidates were randomly divided into placebo or synthetic teardrop (E) and Tetracaine eye drop (T) groups, so 3 drops of each solution were dropped in four directions of patients' eye immediately after applying anesthesia and before surgery. The incidence and severity of OCR during the stages of muscle release and incision (cutting), hemodynamic changes, the required time for OCR recovery and atropine dose were assessed.
RESULTS
OCR was more seen in release phase compared to cutting phase. There were no significant differences between two group regarding the incidence and severity of OCR in the release phase (p > 0.05), but the incidence and severity of OCR in the cutting phase was more in group E than group T (p = 0.02, for both). The duration of OCR improvement (p-value = 0.74) and Atropine consumption (p-value = 0.92) did not differ between the groups.
CONCLUSION
Tetracaine eye drop only reduces the incidence and severity of OCR during the incision stage of strabismus surgery.
Topics: Adolescent; Anesthesia, Local; Anesthetics, Local; Child; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Oculomotor Muscles; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Reflex, Oculocardiac; Strabismus; Tetracaine; Young Adult
PubMed: 30831045
DOI: 10.1080/09273972.2018.1561732 -
Journal of Pediatric Ophthalmology and... 2023To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask...
PURPOSE
To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask tolerance, and separation from parents in children who would undergo strabismus surgery.
METHODS
A total of 74 patients aged 2 to 11 years, were divided into two groups. The dexmedetomidine group (n = 37) received 1 mcg/kg of dexmedetomidine and the midalozam-ketamine group (n = 37) received 0.1 mg/kg of midazolam and 7.5 mg/kg of ketamine combination intranasally. Mean arterial pressure, peripheral oxygen saturation, Ramsay Sedation Scale values, and heart rate were recorded before and after the premedication. The children's separation from the family scores were evaluated and recorded. The mask compliance was evaluated and recorded. Patients who developed oculocardiac reflex and were administered atropine were recorded. In the postoperative period, nausea and vomiting, recovery times, and postoperative agitation were evaluated.
RESULTS
Ramsay Sedation Scale scores, mask acceptance, and family separation scores were similar in both groups ( > .05). Oculocardiac reflex was observed more in the dexmedetomidine group ( = .048). Atro-pine requirement and postoperative nausea and vomiting rates were similar in both groups ( > .05). Mean arterial pressures and heart rates were significantly lower in the dexmedetomidine group during the pre-medication period. The recovery time was longer in the midazolam-ketamine group ( < .001). The incidence of postoperative agitation was significantly lower in the midazolam-ketamine group ( = .001).
CONCLUSIONS
The sedation efficacy of intranasal dexmedetomidine and midazolam-ketamine combination that were given in premedication was similar. Oculocardiac reflex was observed more with dexmedetomidine. The recovery time was prolonged in the midazolam-ketamine group, but postoperative agitation was observed less. .
Topics: Child; Humans; Midazolam; Ketamine; Dexmedetomidine; Hypnotics and Sedatives; Premedication; Strabismus
PubMed: 36803239
DOI: 10.3928/01913913-20221219-01 -
American Journal of Ophthalmology Case... Jun 2017To review the physiology, presentation and management of the oculocardiac reflex (OCR) by describing a case of the OCR associated with an orbital foreign body and...
PURPOSE
To review the physiology, presentation and management of the oculocardiac reflex (OCR) by describing a case of the OCR associated with an orbital foreign body and complete ocular prolapse through a large orbital floor fracture in a 40-year-old male following a motor vehicle accident.
OBSERVATIONS
The patient demonstrated marked bradycardia and hypotension necessitating intubation and medical therapy for autonomic shock. A computed tomography (CT) showed a total blow out floor fracture and complete dislocation of a radiographically intact globe with uninterrupted rectus muscle attachments into the left maxillary sinus. He was taken to the operating room for urgent repair resulting in subsequent termination of severe OCR.
CONCLUSIONS AND IMPORTANCE
The oculocardiac reflex can precipitate marked bradycardia and hypotension in the setting of trauma with significant orbital and maxillofacial injury. Prompt identification and management with vagolytic agents or definitive surgical intervention may prevent morbidity or mortality.
PubMed: 29260043
DOI: 10.1016/j.ajoc.2017.01.004 -
Veterinary Ophthalmology Sep 2014This investigation characterizes the occurrence of oculocardiac reflex (OCR) in conscious rabbits and dogs by observing the effect of an ocular compression stimulus on...
OBJECTIVE
This investigation characterizes the occurrence of oculocardiac reflex (OCR) in conscious rabbits and dogs by observing the effect of an ocular compression stimulus on heart rate (HR).
ANIMALS STUDIED
Thirty-four clinically healthy adult rabbits and 15 clinically healthy adult Beagle dogs were studied.
PROCEDURES
An electrocardiogram was used to record the heart rhythm and HR continuously. Digital pressure was exerted over the eyelid on right eye, left eye and both eyes together for 1 min, with one-minute intervals between each compression. Variations in HR were observed in each minute by counting complexes on the electrocardiographs.
RESULTS
There were no differences in HR between stages without ocular compressions both in dogs and in rabbits. HR reduction caused by ocular compression was statistically significant in rabbits only when both eyes were compressed in contrast with all stages without compression. In dogs, a statistically significant reduction in HR was seen during compression of just the right eye or the left eye compared with the baseline HR, and when both the right and left eyes were compressed together compared with baseline or after compression of the right eye. In dogs, compression of individual eyes produced a change similar to that seen during compression of both eyes.
CONCLUSIONS
This study shows that OCR can occur during experimental ocular compression in conscious rabbits and Beagle dogs and characterizes the reduction in HR. Knowledge of this physiological response is important for veterinary anesthetists and ophthalmologists during ophthalmic surgery or eye manipulations.
Topics: Animals; Dogs; Female; Heart Rate; Male; Rabbits; Reflex, Oculocardiac; Stress, Mechanical
PubMed: 23803170
DOI: 10.1111/vop.12077 -
European Journal of Ophthalmology Nov 2021To evaluate the efficacy and safety of peribulbar anesthesia during strabismus surgery.
PURPOSE
To evaluate the efficacy and safety of peribulbar anesthesia during strabismus surgery.
METHODS
Medical records of patients undergoing strabismus surgery and peribulbar anesthesia were reviewed. The overall efficacy of peribulbar anesthesia was evaluated as requirement of supplemental peribulbar anesthesia, impossibility to perform eye muscles surgery due to inadequate efficacy of the block and peribulbar block complications that occurred up to 6 weeks postoperatively. Presence of oculocardiac reflex (OCR) and presence of decreased visual acuity and afferent pupillary defect postoperatively were reported.
RESULTS
A total of 510 patients comprised our study group. The total amount of peribulbar injections was 717. Four patients (0.7%) required supplemental injection in the superonasal quadrant. Five of 510 (0.9%) required an anesthesiologic intervention with intravenous atropine. Eighty patients of 510 (15.6%) complained about transitory complete ptosis and/or amaurosis postoperatively. No complications were observed up to 6 weeks postoperatively.
CONCLUSION
Peribulbar anesthesia was an effective and safe option during strabismus surgery in adult patients.
Topics: Adult; Anesthesia, Local; Anesthetics, Local; Humans; Oculomotor Muscles; Reflex, Oculocardiac; Strabismus
PubMed: 33225731
DOI: 10.1177/1120672120974947 -
Frontiers in Neurology 2017The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility... (Review)
Review
BACKGROUND
The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR in 1999, there is an ongoing discussion about a more emergent clinical definition. In this work, the author worked out an approach to such an improved definition.
METHODS
In this study, a grounded theory approach was used. Literature about TCR was systematically identified through PubMed (MEDLINE), EMBASE (Ovid SP), and ISI Web of Sciences databases from 1/2005 until 8/2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. A grounded theory approach was used to analyze and interpret the data through a synthesis by the researcher's perspectives, values, and positions.
RESULTS
Out of the included studies, the authors formed available data to an update of the understanding of changes in hemodynamic parameters (HR and blood pressure) in a TCR. According to this update, an HR deceleration should be a constant observation to identify a TCR episode while a drop in blood pressure should probably not being fixed to a certain percentage of decrease.
CONCLUSION
The here presented working definition improves our understanding of the TCR. It leads the way to a new understanding of the TCR for a proper clinical definition.
PubMed: 29085328
DOI: 10.3389/fneur.2017.00533