-
Ophthalmology and Therapy Oct 2022Ophthalmic surgery is assumed to be safe, but some operations require general anaesthesia which is associated with a number of potential complications. In addition,...
INTRODUCTION
Ophthalmic surgery is assumed to be safe, but some operations require general anaesthesia which is associated with a number of potential complications. In addition, adverse cardiovascular symptoms, such as severe slowing of the heart rate and, in some cases, cardiac arrest may occur due to the surgical technique. The aim of this study was to determine whether it is possible to predict the occurrence of oculocardiac reflex (OCR) based on heart rate variability (HRV) analysis for autonomic nervous system (ANS) activity assessment measured prior to the induction of anaesthesia and immediately before eyeball traction.
METHODS
Fifty-two adults of both sexes (age range 18-65 years) with American Society of Anesthesiologists (ASA) physical status class 1 and 2 were enrolled in this study. All patients had underwent episcleral buckling under general anaesthesia. High-frequency (HF) changes in HRV are thought to reflect parasympathetic impulse transmission, whereas low-frequency (LF) changes reflect both sympathetic and parasympathetic activity. However, in practice, LF changes can be considered to reflect sympathetic changes. Thus, the LF/HF ratio reflects the actual balance between sympathetic and parasympathetic activity. Based on that, frequency domain HRV parameters from 5-min Holter electrocardiogram recordings before anaesthesia induction and before eyeball traction were used for the analysis. The statistical analysis also included patient age, sex, ASA status and preanaesthesia and premanoeuvre heart rate and blood pressure.
RESULTS
Data from 42 patients were analysed. Oculocardiac reflex was observed in 32 patients (76.2%). No difference was found in the analysed parameters between patients with and without oculocardiac reflex. There was no relationship between the incidence of the OCR and the analysed parameters.
CONCLUSION
The prediction of OCR based on initial ANS tone was not possible, and the initial heart rate, blood pressure, age, sex, and ASA status were not helpful for the identification of patients at risk of this reflex.
TRIAL REGISTRATION
ClinicalTrials.gov identifier no.: NCT01714362.
PubMed: 35913657
DOI: 10.1007/s40123-022-00549-0 -
Journal of the American Veterinary... Jan 2020
Topics: Anesthesia; Animals; Bradycardia; Dog Diseases; Dogs; Male; Reflex, Oculocardiac
PubMed: 31910081
DOI: 10.2460/javma.256.2.176 -
American Journal of Otolaryngology 2020The purpose of this study is to determine whether bradycardia associated with the oculocardiac reflex is a significant source of morbidity in the post injury period...
PURPOSE
The purpose of this study is to determine whether bradycardia associated with the oculocardiac reflex is a significant source of morbidity in the post injury period following orbital floor fractures in children.
MATERIALS/METHODS
A retrospective review of all pediatric patients who presented to our emergency department with an orbital floor fracture from May 1, 2016 to June 1, 2018 were included. Basic demographic data was collected as well as mechanism of injury, presence of bradycardia, and time to operating room. Morbidity was based on the need for medications to treat bradycardia.
RESULTS
Thirty-five pediatric patients with orbital floor fractures were reviewed. 6 (17.1%) patients had post injury bradycardia, with one patient requiring medication to stabilize their heart rate. There was no statistically significant difference in sex, race/ethnicity, or age in patients with or without bradycardia (p > 0.05) however there was a significant relationship between bradycardia and need for operative repair (X = 7.88, df = 1, p = 0.005). The most common mechanism of injury was motor vehicle collision (45.7%). The average time to the operating room was 145 h (6.04 days).
CONCLUSIONS
While activation of the oculocardiac reflex is a legitimate concern in the post injury period, there is unlikely to be significant morbidity due to bradycardia, and the greater concern should be for the ischemic muscle injury incurred from the fracture.
Topics: Accidents, Traffic; Adolescent; Bradycardia; Child; Female; Humans; Male; Morbidity; Orbital Fractures; Reflex, Oculocardiac; Retrospective Studies; Time Factors
PubMed: 32485298
DOI: 10.1016/j.amjoto.2020.102553 -
Veterinary Anaesthesia and Analgesia Nov 2023
Topics: Rabbits; Animals; Reflex, Oculocardiac; Reflex; Ultrasonography; Ultrasonography, Interventional
PubMed: 37604727
DOI: 10.1016/j.vaa.2023.08.003 -
Journal of Cranio-maxillo-facial... May 2021The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is...
The trigeminocardiac reflex: Does the activation pathway of its efferent arc affect the intensity of the hemodynamic drop during the management of maxillofacial fractures?
The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type. There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated. 1Introduction.
Topics: Humans; Mandible; Reflex; Reflex, Trigeminocardiac; Retrospective Studies; Trigeminal Nerve
PubMed: 33632536
DOI: 10.1016/j.jcms.2021.02.004 -
Journal of the Korean Association of... Aug 2021The oculocardiac reflex is a trigeminal-vagal reflex that manifests as cardiac arrythmias, most often bradycardia. The reflex can be triggered by manipulation of...
The oculocardiac reflex is a trigeminal-vagal reflex that manifests as cardiac arrythmias, most often bradycardia. The reflex can be triggered by manipulation of periorbital structures and unintended pressure on the bulbus oculi maxillofacial procedures. In this brief communication, we describe an unusual trigger of the oculocardiac reflex during maxillofacial surgery that resulted in severe bradycardia. This case highlights the need for careful securement of medical devices and attention to surgical technique to avoid undue pressure on draped fascial structures.
PubMed: 34462391
DOI: 10.5125/jkaoms.2021.47.4.335 -
Journal of the American Veterinary... Aug 2019To determine the prevalence of and covariates associated with the oculocardiac reflex (OCR) occurring in dogs during enucleations.
OBJECTIVE
To determine the prevalence of and covariates associated with the oculocardiac reflex (OCR) occurring in dogs during enucleations.
SAMPLE
145 dogs that underwent enucleation at 2 veterinary teaching hospitals between January 2010 and June 2015.
PROCEDURES
Information was collected from the medical records of included dogs regarding age and body weight at hospital admission, breed (for classification of brachycephalic status), and whether they had received anticholinergic drugs or a retrobulbar nerve block (RNB) prior to enucleation. An OCR was considered to have occurred if there was a sudden decrease of ≥ 30% in heart rate from the baseline value (mean heart rate prior to the sudden decrease) during surgery in the absence of intraoperative administration of opioids or α-adrenoceptor agonists. Associations were explored between the collected data and the prevalence of OCR by means of binomial logistic regression.
RESULTS
4.8% (7/145) of dogs had an OCR noted during enucleation. Dogs that received a preoperative RNB (n = 82) had significantly lower odds of an OCR being observed than dogs that received no preoperative RNB (OR, 0.12). No association with OCR was identified for age or brachycephalic conformation or for preoperative administration of anticholinergic drugs.
CONCLUSIONS AND CLINICAL RELEVANCE
These findings suggested that preoperative administration of an RNB, but not preoperative administration of anticholinergic drugs, was associated with a lower prevalence of OCR in dogs during enucleations.
Topics: Analgesics, Opioid; Animals; Dogs; Heart Rate; Nerve Block; Prevalence; Reflex, Oculocardiac
PubMed: 31355722
DOI: 10.2460/javma.255.4.454 -
BMC Ophthalmology Apr 2018To investigate surgical factors associated with the occurrence of oculocardiac reflex (OCR) and changes in heart rate (HR) during strabismus surgery.
BACKGROUND
To investigate surgical factors associated with the occurrence of oculocardiac reflex (OCR) and changes in heart rate (HR) during strabismus surgery.
METHODS
Patients who underwent strabismus surgery under general anesthesia were enrolled in this study. The HR during surgery was measured at baseline, and at the following points during surgery: traction of the muscle, maximal increase after traction (adrenergic phase), and the cutting of the muscle. OCR was defined as an HR reduction of more than 20% at traction of the muscle, when compared to baseline HR. The HR at each stage during the surgery was compared between patients with and without OCR.
RESULTS
A total of 162 operated muscles from 99 patients were enrolled. The incidence of OCR was 65% in patients. In patients with two muscle surgeries, there were significantly more OCRs in the first operated muscle than in the second operated muscle (p < 0.01). The difference in the decrease in HR in patients with OCR was significantly lower than that in patients without OCR at traction of the muscle, the adrenergic phase, and the cutting of the muscle (all, p < 0.01). The first operated muscle was a significant risk factor associated with the occurrence of OCR (OR = 3.95, p < 0.01).
CONCLUSION
The first operated muscle in patients with two muscle surgeries was a significant risk factor for OCR. Decreased HR at the traction of the muscle during surgery did not fully recover in patients with OCR.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Heart Rate; Humans; Infant; Male; Middle Aged; Oculomotor Muscles; Reflex, Oculocardiac; Risk Factors; Strabismus; Young Adult
PubMed: 29673326
DOI: 10.1186/s12886-018-0771-9 -
Clinical Ophthalmology (Auckland, N.Z.) 2019Strabismus surgery is often performed on children and adults as a quick-turnover, outpatient procedure under general anesthesia. Ideal methods to reduce post-operative...
BACKGROUND
Strabismus surgery is often performed on children and adults as a quick-turnover, outpatient procedure under general anesthesia. Ideal methods to reduce post-operative pain and nausea are not yet perfected. We postulated that a simple topical anesthetic drop after surgery might help.
METHODS
In a prospective study of oculocardiac reflex (OCR) and strabismus surgery, a cohort of ongoing patients either received proparacaine immediately post-op, or none. Co-variables were Intraoperative opioid and OCR, patient age, type of surgery. Several post-operative recovery outcome variables were prospectively monitored.
RESULTS
Sixty strabismus surgery patients (age 15±22 years) received proparacaine 1% while another 80 (16.5±22 years) received none; both received topical antibiotic-steroid ointment. Pain and nausea (Likert scale) were not impacted by covariables complexity of case, age less than 3.5, OCR >33% drop, intraoperative opioid or neuro-status. Immediate post-op heart rate was lower if OCR >33% and if opioids used. Time until discharge was shorter in younger patients. Proparacaine did not impact outcome variables, except in patients younger than 3.5 years when post-op pain was worse.
CONCLUSION
Post-op topical anesthetic either produced no difference, or worsened post-op pain and recovery. This prospective study does not support the use of topical anesthetic drop to reduce post-strabismus pain and nausea.
CLINICAL TRIALS REGISTRATION
NCT03672435, Strabismus Recovery With Proparacaine and Oculocardiac Reflex (OCRprop).
PubMed: 31819352
DOI: 10.2147/OPTH.S230498 -
Pediatric Emergency Care Jul 2020We describe the case of a 6-year-old boy who presented to a tertiary care emergency department after a motor vehicle accident with facial trauma and bradycardia. The...
We describe the case of a 6-year-old boy who presented to a tertiary care emergency department after a motor vehicle accident with facial trauma and bradycardia. The patient was found to have an orbital floor fracture and inferior rectus muscle entrapment with resulting bradycardia secondary to the oculocardiac reflex. The oculocardiac reflex is an uncommon cause of bradycardia in the setting of trauma but should be considered because it can necessitate surgical intervention.
Topics: Accidents, Traffic; Bradycardia; Child; Diagnosis, Differential; Electrocardiography; Emergency Service, Hospital; Facial Injuries; Humans; Male; Oculomotor Muscles; Orbital Fractures; Reflex, Oculocardiac
PubMed: 29489611
DOI: 10.1097/PEC.0000000000001429