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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 -
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 -
BMJ Case Reports Dec 2019Trigeminocardiac reflex (TCR) is a brainstem reflex triggered by the stimulation of any branch of the fifth cranial nerve along its course, presenting as a reduction in...
Trigeminocardiac reflex (TCR) is a brainstem reflex triggered by the stimulation of any branch of the fifth cranial nerve along its course, presenting as a reduction in heart rate and blood pressure. Oculocardiac reflex is a well-known subtype of TCR. In the case reported here, remarkable arrhythmia followed by bradycardia occurred suddenly in a healthy patient undergoing orthognathic surgery. The heart rhythm recovered when the surgical manipulation ceased, but bradycardia was reproduced when the surgery resumed. This case of TCR is unique in that remarkable arrhythmia first appeared and led to bradycardia; accordingly, intravenous lidocaine and an anticholinergic agent were administered simultaneously instead of anticholinergic agents alone, and were protective. Although TCR rarely occurs during orthognathic surgery, clinicians should be aware of its possibility and able to judge and manage it promptly.
Topics: Administration, Intravenous; Anti-Arrhythmia Agents; Bradycardia; Cholinergic Antagonists; Electrocardiography; Humans; Intraoperative Complications; Lidocaine; Male; Orthognathic Surgical Procedures; Osteotomy, Sagittal Split Ramus; Reflex, Trigeminocardiac; Young Adult
PubMed: 31796445
DOI: 10.1136/bcr-2019-232784 -
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