Abstract
A new method for the detection and recording of the oculocardiac reflex (OCR) is described and applied to 49 healthy infants and children (six months to nine years old) undergoing strabismus surgery under halothane anaesthesia with spontaneous ventilation. Eighty-one extraocular muscles were studied. Square wave stimuli (abrupt and sustained tractions) were definitely more reflexogenic than slow slope stimuli (very gradual, progressive and gentle tractions). Vagai escape, as well as fatigue of the OCR, are graphically documented and analysed. In this series, using well-defined and controlled tractions, the medial reclus was not more reflexogenic than the other extraocular muscles. Hypercapnia was an important adjuvant factor of the OCR. Controlled ventilation is recommended. The routine use of intravenous amicholinergic drugs is briefly discussed. Prevention of the OCR, and prophylaxis of cardiac arrhythmias during strabismus surgery, now seem to be placed on a more rational basis.
Résumé
Les auteurs décrivent une nouvelle méthode d’enregistrement graphique pour l’étude du réflexe oculocardiaque (ROC) et l’emploient chez 49 enfants (six mois à neuf ans; état physique l de la classification ASA) soumis à des corrections de strabisme et anesthésiés à l’halothane en respiration spontanée. Les stimulations brusques et soutenues étaient définitivement plus réfiexogènes que les stimulations progressives et délicates (P = 0.03). L’échappement vagai et la fatigue du ROC sont graphiquement documentés et analysés. L’emploi de stimulations d forme et à intensité bien définies révéla que le droit interne n’était pas plus réfiexogène que les autres muscles extrinsèques de l’il. L’hypercapnie était un facteur adjuvant important dans le déclenchement du ROC. La respiration contrôlée est recommandée, au moins lors des tractions musculaires. L’usage routinier d’agents anticholinergiques par voie intraveineuse est brièvement discuté. La prophylaxie du ROC et la prophylaxie des arythmies cardiaques survenant au cours des corrections de strabisme, sont ainsi placées sur des bases plus rationnelles.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Aschner B. Über einen bisher noch nicht beschriebenen Reflex von Auge auf Krieslauf und Atmung: Verschinden des Radialispulses bei Druk auf das Auge. Wein Klin Wschr 1908; 21: 1529–30.
Dagnini, G. Intorno ad un riflesso provocato in alcuni emiplegici collo stimolo della cornea e colla pressione sul bulbo oculare. Boll Sci Med 1908; 8: 380–1.
Salamagne JC. Le réflexe oculo-cardiaque - L’anesthésie en Ophtalmologie - XXVII Congrès National d’Anesthésie et de Réanimation, Bordeaux, France. Pp 41/–59 (1979).
Katz RL, Bigger JT. Cardiac arrhythmias during anesthesia and operation. Anesthesiology 1970; 33: 193–213.
Schwanz H. Oculocardiac reflex: is prophylaxis necessary? InMark LC andNgai SH, Eds. Highlights of clinical anesthesiology. Pp 111–4. Harper and Row. N.Y. (1971).
Pantinen PJ. The importance of the oculocardiac reflex during ocular surgery. Acta Ophthal Suppl 1966; 86: 7–66.
Anderson RL. The blepharocardiac reflex. Arch Ophthal 1978; 96: 1418–20.
Kwik RSH. Marcus Gunn syndrome associated with an unusual oculo-cardiac reflex. Anaesthesia 1980; 35: 46–9.
Mougeot A, Duverger P. Bradycardie et réflexe oculo-cardiaque dans les traumatismes oculaires, crâniens, encéphaliques. Presse Méd 1917; 25: 730–2.
Bailey JH. The oculocardiac reflex: report of a case exhibiting a marked reaction following enucleation of the eye-ball. Am J Ophthal 1935; 18: 22–25.
Donlon JV. Jr. Anesthesia for eye, ear, nose and throat surgery. InMiller RD, Ed. Anesthesia Vol. H: 1272–73. Churchill Livingstone, N.Y. (1981).
Dewar KMS, Wishart HY. The oculocardiac reflex. Proc Roy Soc Med 1976; 69: 373–4.
Rhode J, Grown E, Bajares C, Anselmi A, Cuprites M, Rivas C. A study of electrocardiographic alterations occuning during operations on the extraocular muscles. Am J Ophthal 1958; 46: 367–82.
Bietti GB. Problems of anesthesia in strabismus surgery, Int Ophthal Clin 1973; 13(2): 727–37.
Cooper J, Medow N, Dibble C. Mortality rate in strabismus surgery. J Am Optom Assoc 1982; 53: 391–5.
Kirsch RE, Samel P, Kugel V, Axelrod S. Electrocardiographic changes during ocular surgery and their prevention by retrobulbar injection. Arch Ophthal 1957; 58: 348–56,
Mallinson FB, Coombes SK. A hazard of anaesthesia in ophthalmic surgery. Lancet 1960; 1: 574–5.
Smith RB, Douglas H, Petruscak J. The oculocardiac reflex and sino-atrial arrest. Can Anaesth Soc J 1972; 19: 138–42.
Landman ME, Ehrenfeld D. Ventricular fibrilla tion following eyeball pressure in a case of paroxysmal supraventricular tachycardia. Am Heart J 1952; 43:791–5.
Sorenson EJ, dimore JE. Cardiac arrest during strabismus surgery - a preliminary report. Am J Ophthal 1956; 41: 748–52.
Sold M, Rothhammer A, Schäfer WD. Atropine or glycopyrrolate for prevention of the oculocardiac reflex in children. A comparative study under standardized conditions. 6th Europ. Congress Anaesthesiology. Anaesthesia (Volume of Summaries): 494(1982).
Alexander JP. Reflex disturbances of cardiac rhythm during ophthalmic surgery. Br J Ophthal 1975; 59: 518–24.
Moonie GT, Rees DL, Elton D. The oculocardiac reflex during strabismus surgery. Can Anaesth Soc J 1964; 11: 621–32.
Welhaf WR, Johnson DC. The oculocardiac reflex during extraocuiar muscle surgery. Arch Ophthal 1965; 73: 43–5.
Deacock AR.Oxer HF. The prevention of reflex bradycardia during ophthalmic surgery. Br J Anaesth 1962: 34: 451–7.
Apt L, henberg S, Gaffney WL. The oculocardiac reflex in strabismus surgery. Am J Ophthal 1973; 76: 533–6.
Berler DK. The oculocardiac reflex. Am J Ophthal 1963; 56: 954–9.
Miralchur RK, Jones CJ, Dundee JW, Archer DB. I.M. or I.V. atropine or glycopyrrolate for the prevention of the oculocardiac reflex in children undergoing squint surgery. Br J Anaesth 1982; 54: 1059–63.
Soliman MG, Laberge R. The use of the Bain circuit in spontaneously breathing paediatric patients. Can Anaesth Soc J 1978; 25: 276–81.
Steward DJ. Manual of pediatrie anesthesia. Longman Canada Ltd., Don Mills, Ontario (1979).
Eger EI. Atropine, scopolamine and related compounds. Anesthesiology 1962; 23: 365–83.
Hunsley JE, Bush GH, Jones CJ. A study of glycopyrrolate and atropine in the suppression of the oculocardiac reflex during strabismus surgery. Br J Anaesth 1982; 54; 459–64.
Mirakhur RK, Jones CJ. The oculocardiac reflex-pretreatment with atropine or glycopyrrolate in children. 6th Europ. Congress Anaesthesiology. Anaesthesia (Volume of Summaries); 286–7 (1982).
Author information
Authors and Affiliations
Additional information
Supported in part by Research Grant 862 from La Fondation J JStine-Lacoste-Beaubicn (Hôpital Sainte-Justine, Montréal).
Rights and permissions
About this article
Cite this article
Blanc, V.F., Hardy, JF., Milot, J. et al. The oculocardiac reflex: a graphic and statistical analysis in infants and children. Can Anaesth Soc J 30, 360–369 (1983). https://doi.org/10.1007/BF03007858
Issue Date:
DOI: https://doi.org/10.1007/BF03007858