Oculocardiac reflex during pediatric strabismus surgery

Conclusion: OCR and SB can be life threaten situations during strabismus surgery.It is important to know risky muscle groups and conditions for the physicians.

📌 3 Key Takeaways

🎯

Objective & Hypothesis:Aim: To evaluate the oculocardiac reflex rate (OCR) during the pediatric age group strabismus surgery Material and Method: 354 extraocular muscles (EOM) of 190 pediatric age group patients with an average age of 6.34±3.39 years, who underwent strabismus surgery under general anesthesia were studied to evaluate OCR rates.

📊

Key Findings & Data:Heart rate of each patient recorded by electrocardiography before and after the EOM traction.

💡

Conclusion & Impact:Conclusion: OCR and SB can be life threaten situations during strabismus surgery.It is important to know risky muscle groups and conditions for the physicians.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Domain Parameters

Abstract

Aim: To evaluate the oculocardiac reflex rate (OCR) during the pediatric age group strabismus surgery Material and Method: 354 extraocular muscles (EOM) of 190 pediatric age group patients with an average age of 6.34±3.39 years, who underwent strabismus surgery under general anesthesia were studied to evaluate OCR rates. Heart rate of each patient recorded by electrocardiography before and after the EOM traction. Heart rates ≤60 beat /min, accepted as critical point to stop muscle traction. ≥%20 decreases from the baseline heart rate accepted as positive OCR. Results: The highest OCR rate was found in superior rectus group as %55. Lateral rectus (LR) group was the least with %13.5. Statistical differences were found significant for OCR rates between the all muscle groups (p=0.000). Positive OCR total rate was calculated as %36.2. Sinusal bradicardy (SB) rate was highest in the inferior oblique (IO) group with %22 and was lowest in the LR group with %12.8. For the entire group it was % 12.8. Life threated arrhythmias and dysrhythmias did not occure in any of the patients. Conclusion: OCR and SB can be life threaten situations during strabismus surgery.It is important to know risky muscle groups and conditions for the physicians.

Özet

Amaç: Pediyatrik yaş grubu şaşılık cerrahisinde okülokardiyak refleks (OKR) oranlarını değerlendirmek. Gereç ve Yöntem: Kliniğimizde genel anestezi altında şaşılık cerrahisi uygulanan, yaş ortalamaları 6.34 ± 3,39 yıl olan çocuk yaş grubundaki 190 hastanın 354 ekstraoküler kası (EOK), OKR oranları açısından prospektif olarak incelendi. EOK’a traksiyon yapılmadan önce ve traksiyon sırasında kalp hızları elektrokardiyografi ile kaydedildi.60 atım/dk ve altı kalp hızları kas traksiyonuna son vermek için kritik sınır ve bazal kalp hızından %20 veya daha fazla düşüş pozitif okülokardiyak refleks olarak kabul edildi. Bulgular: Pozitif OKR oranları %55.0 ile en yüksek üst rektus grubunda izlendi. En düşük oran %13.5 ile lateral rektus (LR) grubunda gözlendi. Kas grupları arasında OKR oranları açısından fark istatistiksel olarak anlamlı bulundu (p=0.000). Tüm çalışma grubu için, pozitif OKR oranı % 36.2 olarak hesaplandı. Sinüs bradikardi gelişimi, % 22 ile en yüksek inferior oblik (İO) grubunda izlendi.En düşük oran ise % 5.6 ile LR grubunda gözlendi. Sinüs bradikardi gelişme oranı tüm çalışma grubu için % 12.8 olarak bulundu. Hayatı tehdit eden disritmiler veya asistoli hastaların hiçbirinde gözlenmedi. Sonuç: Şaşılık cerrahisi esnasında ortaya çıkan OKR ve sinüs bradikardisi, hayatı tehdit eden klinik durumlar olabildiğinden riskli kas guruplarının belirlenmesi ve yol açan nedenlerin bilinmesi klinisyenler için önemlidir.

🔖

Cite This Article

ÖZBEK, A., AKAR, S., GÖKYİĞİT, B., UYAR, Ö., AYGÜN, F., YÜKSEL, A., YILMAZ, Ö. F. (2008). Oculocardiac reflex during pediatric strabismus surgery. MN Oftalmoloji, Cilt: 15 - Sayı: 3, 171–176. https://ajindex.com/articles/296137

📄 Full Text PDF Viewer

Open in New Tab ↗

↗New Tab

📄

PDF görüntüleyici hazırlanıyor...

References (1)

Allison CE, De Lange JJ, Koole FD, Zuurmond WW, Ros HH, Van Schagen NT. A comparison of the incidence of the ocu locardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in chil dren.Anesth Analg 2000;90.306-10 2. Kim WO, Kil HK, Lee JS, Lee JH. Prediction of oculocardiac reflex in strabismus surgery using neural networks.Yonsei Medical Journal 1999; 40(3):244-7 3. Loewinger J. Friedman-Neiger I, Cohen M, Levi E. Effects of atracurium and pancuronium on the oculocardiac reflex in children. Anesth Anolg 1991;73(1):25-8 4. Gold RS, Pollard Z, Buchwald IP. Asystole due to the oculo cardiac reflex during strabismus surgery: a report of two cases.Ann Ophthalmol 20(12):473-5 5. Blanc VF, Hardy JF, Milot J, Jacob JL.The oculocardiac re flex: a graphic and statistical analysis in infants and chil dren.Can Anaesth Soc J 1983;30(4):360-9 6. Yamashita M. Oculocardiac reflex and the anesthesiologist. Middle East J Anesthesiol 1986;8(5):399-415. 7. Tramer MR. Fuchs-Buder T, Samsonetti A, Rıfat K. Low inci dence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery. Can J Anaesth 1999; 41(8):830-5. 8. Smith RB. Death and the oculocardiac reflex. Can J Anesthesia 1994; 41 (8):760. 9. Fayon M, Gaultier M, Blanc VF, Ahranheim GA, Michaud J. Intraoperative cardiac arrest due to the oculocardiac reflex and subsequent death in a child with occult Epstein-Barr- Virus myocarditis. Anaesthesiology 1995; 83(3):622-4. 10. Eustis HS, Eswirth CC, Smith DR. Vagal responses to ad justable sutures in strabismus correction. Am J Ophthalmol 1992;114(3):307-10. 11. Mirakhur RK, Jones CJ, Dundee JW, Archer DB. l.m. or i.v. at ropine or glycopyrrolate for the prevention of oculocardiac re flex in children undergoing squint surgery. Br J Anaesth 1982; 54(10):1059-63 12. Kimball A. Emergency management of the pediatric patient cases, algoritms, evidence.Philadelphia: W&W Lippincott. 2007:23 13. Goerlich TM, Foja C, Olthoff D. Effects of sevoflurane versus propofol on oculocardiac reflex, a comparative study in 180 children. Anaesthesiol Reanim 2000;25(1):17-21. 14. Kim HS, Kim SD, Kim CS, Yum MK. Prediction of oculocar diac reflex from pre operative linear and nonlinear heart rate dynamics in children. Anesthesia 2000;55(9):847-52 15. Song NW, Park KS, Cho SD, Lee KH, Kim JH. The oculocar diac reflex during strabismus surgery in children. Korean J Anesthesiol 1987;20(6):824-9 16. Katz RL,