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Anesthesia and Analgesia Jan 2023The aim of this study was to explore whether ice slush (IS) causing local hypothermia can effectively inhibit the oculocardiac reflex (OCR) during strabismus surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this study was to explore whether ice slush (IS) causing local hypothermia can effectively inhibit the oculocardiac reflex (OCR) during strabismus surgery.
METHODS
This prospective, randomized, double-blind study included 58 patients with concomitant strabismus scheduled for lateral rectus (LR) recession under general anesthesia. Patients were randomly allocated to receive IS (IS group) or standard treatment (control group) with sterile saline at room temperature before surgery. OCR was defined as a sudden decrease in heart rate (HR) of >15% from baseline. If one incidence of the OCR was found in 1 patient in any stage (0/I/II/III), the patient was defined as an OCR responder, and the incidence of overall OCR was the incidence of OCR responders. The primary outcome was the incidence of overall OCR during all stages of the surgery, which was analyzed by the Z test and computed based on the absolute risk difference with 2-sided 95% confidence intervals (CIs) using the Newcombe method.
RESULTS
The overall OCR occurred in 19 of 29 patients (62.5% [95% CI, 45.7-82.1]) in the IS group and 28 of 29 patients (96.6% [95% CI, 82.2-99.9]) in the control group (absolute risk difference, -31.0% [95% CI, -49.4 to -11.0]; Z test, P < .001), which demonstrated that the incidence of overall OCR in IS group was significantly lower than that in the control group.
CONCLUSIONS
IS on the ocular surface causing local hypothermia is a promising and easily accessible method to reduce the overall OCR, which can improve the safety of strabismus surgery.
Topics: Humans; Ice; Reflex, Oculocardiac; Prospective Studies; Hypothermia; Strabismus
PubMed: 36322461
DOI: 10.1213/ANE.0000000000006239 -
Emergency Medicine Australasia : EMA Aug 2018
Topics: Adult; Alcohol Drinking; Bradycardia; Heart Arrest; Humans; Male; Orbital Fractures; Reflex, Oculocardiac; Tomography, X-Ray Computed; Troponin
PubMed: 29797424
DOI: 10.1111/1742-6723.13113 -
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 -
Klinische Monatsblatter Fur... Apr 2024As studies have shown a reduction in the occurrence of the oculocardiac reflex with the addition of local anaesthesia, we changed our care regime accordingly a few years...
BACKGROUND
As studies have shown a reduction in the occurrence of the oculocardiac reflex with the addition of local anaesthesia, we changed our care regime accordingly a few years ago. To promote and establish better patient care, we retrospectively analysed the files of our patients who underwent strabismus surgery from 2013 to 2021 in order to compare strabismus surgery under general anaesthesia with and without local anaesthetics in a routine clinical setting.
PATIENTS AND METHODS
Data from 238 adult patients who had undergone strabismus surgery could be extracted from the files: G1: n = 102, only general anaesthesia; G2: n = 136, preoperative application of tetracaine eye drops and intraoperative subtenon lidocaine/levobupivacaine in addition to general anaesthesia. We compared the two groups in regard to the frequency of oculocardiac reflex, the amount of atropine needed to treat, as well as the amount of antiemetic and analgesic medication given, and time spent in the recovery room.
RESULTS
Mean age of G1 was 50 years and 52 years in G2. There was no significant difference between the kind of surgeries (recessions/resections), the number of patients who had undergone a reoperation, or the duration of the operations. Adding local anaesthetics resulted in significantly less occurrence of oculocardiac reflex (p = 0.009), a reduction in the need for atropine, analgesic, or antiemetic medication, as well as reduced time in the recovery room.
CONCLUSION
As this increases patient safety and comfort and is cost-effective (less time in the recovery room), we recommend adding perioperative local anaesthesia to strabismus surgery performed under general anaesthesia.
Topics: Humans; Strabismus; Anesthesia, General; Male; Female; Middle Aged; Anesthetics, Local; Adult; Retrospective Studies; Reflex, Oculocardiac; Anesthesia, Local; Lidocaine; Intraoperative Care; Preoperative Care; Tetracaine; Young Adult; Aged; Ophthalmologic Surgical Procedures; Treatment Outcome
PubMed: 38653301
DOI: 10.1055/a-2268-9411 -
Seminars in Ophthalmology 2017To describe the clinical and pathological features of malignant transformation of an optic nerve melanocytoma over 25 years, associated with spontaneous extensive tumor...
Malignant Transformation of Optic Nerve Melanocytoma into Melanoma Associated with Ocular Ischemic Syndrome and Oculocardiac Reflex: Case Report and Review of the Literature.
PURPOSE
To describe the clinical and pathological features of malignant transformation of an optic nerve melanocytoma over 25 years, associated with spontaneous extensive tumor necrosis, neovascular glaucoma, ocular ischemic syndrome, and oculocardiac reflex.
PROCEDURES
A 60-year-old Caucasian female presented with acute severe left ocular pain and glaucoma with an intraocular pressure of 80 mmHg and bradycardia (28-40 beats/min).
RESULTS
Histopathological examination of the enucleated eye showed features of malignant transformation of a spontaneously necrotic optic nerve melanocytoma associated with ocular ischemic syndrome and neovascular glaucoma.
CONCLUSIONS
Yearly follow-up and awareness of possible but well-documented malignant transformation, even over several decades, is recommended. This case presents malignant transformation of an optic nerve melanocytoma associated with the common complications described in the literature over the years. Of particular interest was the development of oculocardiac reflex in this patient.
Topics: Cell Transformation, Neoplastic; Female; Fluorescein Angiography; Fundus Oculi; Humans; Melanoma; Middle Aged; Nevus, Pigmented; Optic Disk; Optic Nerve; Optic Nerve Neoplasms; Tomography, X-Ray Computed
PubMed: 26154561
DOI: 10.3109/08820538.2015.1046558 -
Plastic and Reconstructive Surgery.... Sep 2022Bradycardia and asystole due to oculocardiac reflex (OCR) are potential intraoperative complications of periocular surgery. We report a case of asystole due to OCR that...
Bradycardia and asystole due to oculocardiac reflex (OCR) are potential intraoperative complications of periocular surgery. We report a case of asystole due to OCR that occurred during surgical repair performed 40 hours after an orbital blowout fracture. The patient had vomiting, bradycardia, and ocular motility disorder before the operation. During the operation, asystole occurred when the entrapped tissue was grasped with forceps. After administration of anticholinergic drugs, the heart promptly resumed beating, and no sequelae due to asystole were observed after surgery. Before and during periocular surgery, it is important for the surgeon to maintain a protective surgical procedure and communicate appropriately with the anesthesiologist, including discussion of risks and emergency measures. In addition, prolonged entrapment of the extraocular muscles is likely to cause irreversible damage, so it is important to make a diagnosis and perform surgery as soon as possible.
PubMed: 36187280
DOI: 10.1097/GOX.0000000000004544 -
Brazilian Journal of Otorhinolaryngology 2023Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative...
OBJECTIVE
Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures.
METHODS
This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital.
RESULTS
There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p = 0.0046). There were no differences in Hess area ratio by age group.
CONCLUSION
Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures.
Topics: Male; Humans; Child; Adolescent; Retrospective Studies; Orbital Fractures; Diplopia; Algorithms; Disease Progression
PubMed: 36754674
DOI: 10.1016/j.bjorl.2023.01.004 -
Journal of the Korean Association of... Dec 2020Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos...
Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.
PubMed: 33377469
DOI: 10.5125/jkaoms.2020.46.6.428 -
Plastic and Reconstructive Surgery.... May 2022Diplopia is a common symptom after blowout fractures, with an incidence of 43.6%-83%. Although there is some consensus toward surgical correction, diplopia is not always...
UNLABELLED
Diplopia is a common symptom after blowout fractures, with an incidence of 43.6%-83%. Although there is some consensus toward surgical correction, diplopia is not always resolved by surgery. Thus, there is a clinical dilemma for surgeons with regard to performing surgery at a specific time. This review aimed to create an algorithm to support accurate and effective decision-making.
METHODS
We reviewed articles published on PubMed during 2013-2020 regarding orbital fractures. Articles discussing surgical treatment for blowout fractures and diplopia were included. Five reviews, six prospective cohort studies, and 33 retrospective studies were identified. After reviewing and summarizing these articles, a step-by-step algorithm was created.
RESULTS
Most authors advise immediate surgery when a patient presents with either a positive oculocardiac reflex or a "trapdoor" fracture. Early surgical correction is recommended in children to prevent profound muscle damage. In other scenarios, most authors recommend performing surgery within 2 weeks. The algorithm begins with the aspect of motility, including muscle entrapment assessed by computed tomography or limited movement of the extraocular muscle. When there is no abnormality in motility, the algorithm continues to the aspect of position. Generally, an orbital floor defect of more than 50% or 2 cm or an enophthalmos of more than 2 mm is indicated for surgery. However, diplopia may also gradually resolve after improvement of periorbital edema or swelling.
CONCLUSION
We proposed a step-by-step approach to help surgeons make effective decisions concerning surgical correction for patients suffering from blowout fractures with diplopia at different time points.
PubMed: 35558136
DOI: 10.1097/GOX.0000000000004308 -
[Zhonghua Yan Ke Za Zhi] Chinese... Nov 2022Ocular cardiac reflex (OCR) usually occurs in ophthalmic surgery, especially in extraocular muscle(s) surgery. OCR generally can cause sinus bradycardia, arrhythmia,...
Ocular cardiac reflex (OCR) usually occurs in ophthalmic surgery, especially in extraocular muscle(s) surgery. OCR generally can cause sinus bradycardia, arrhythmia, reduced atrial pressure, ventricular tachycardia, ventricular fibrillation, ventricular doublet, dizziness, nausea and other symptoms. Severe cases will appear cardiac arrest, respiratory arrest, etc. Recent studies on the mechanism of OCR and the relationship between surgical operation and anaesthesia in extraocular muscle surgery and the occurrence of OCR are reviewed in this paper in order to reduce the occurrence of OCR and treatment of OCR in extraocular muscle surgery.
Topics: Humans; Oculomotor Muscles; Reflex, Oculocardiac; Strabismus; Bradycardia; Reflex
PubMed: 36348544
DOI: 10.3760/cma.j.cn112142-20220415-00178