Ophthalmologists now realize the importance of the oculocardiac reflex from ocular manipulation. The occurrence of cardiac disturbances has been recognized since 1908. Several authors have believed the mechanisms of the reflex affecting the pulse rate. the conduction system and myocardial contractibility of the heart. For the purpose of the recognition of this reflex, authors performed ocular compression and muscle traction after atropine injection or retrobulbar anesthesia in 135 persons. The results were noted that the reflex is blocked by intravenous atropine injection or retrobular anesthesia. while not by subconjunctival anesthesia or intramuscular atropine injection.
Anesthesia ; Atropine ; Heart ; Heart Rate ; Humans ; Reflex ; Reflex, Oculocardiac* ; Traction

PURPOSE: To investigate the factors that influence development of oculocardiac reflex (OCR) during strabismus surgery and to discuss the preventive strategies. METHODS: We examined patients undergoing surgery for strabismus. One hundred and sixty extraocular muscles of 73 patients were operated and 114 extraocular muscles of 50 patients who were operated under general anesthesia were evaluated. We investigated the incidence of the OCR and subsequent postoperative vaso-vagal response (VVR). RESULTS: An overall rate of 74.0% of the patients and 53.8% of the muscles showed a positive OCR. Under general anesthesia, 74.0% of the patients and 50.9% of the muscles showed a positive OCR. There was a significant difference in the frequency of OCR between the medial rectus and the other muscles (p=0.009). The development of OCR is frequent during muscle traction in strabismus surgery. There was a significant association between positive OCR and subsequent postoperative VVR (p=0.039). CONCLUSIONS: The predictive factors of the OCR during strabismus surgery under general anesthesia were muscle type and procedure. Therefore cardiac monitoring during the operation is needed and gentle manipulation of the extraocular muscles is important especially when the medial rectus muscle. The estimation of OCR will be helpful for prevention of subsequent postoperative VVR.
Anesthesia, General ; Humans ; Incidence ; Muscles ; Reflex, Oculocardiac* ; Strabismus* ; Traction

We perfomed this study to evaluate the incidence of the oculocardiac reflex(OCR) and its difference relative to each extraocular muscles. In addition, preventive methods for oculocardiac reflex were also evaluated. From Febrary 1997 to January 1998, we examined the occurrence of the OCR of 65 patients who underwent strabismus surgery in 123 extraocular muscles under the general anesthesia. Those who showed severe OCR were prepared with retrobulbar injection of 1% lidocaine 2cc or 1% intravenous atropine and observed wheather OCR was prevented. The overall incidence of the OCR was 66.2% and there was no significant difference between the incidence in both eyes(p>0.999). The incidence in each of the extraocular muscles did not show statistically significance when the patients were prepared with preoperative intramuscular atropine(p=0.018). The incidence after intraoperative retrobulbar injection or intravenous atropine was decreased to 27.3% but was not statistically significant(p=0.34).
Anesthesia, General ; Atropine ; Humans ; Incidence ; Lidocaine ; Muscles ; Reflex, Oculocardiac* ; Strabismus*

Under the general anesthesia the effect of topical anesthesia on the incidence of oculocardiac reflex was investigated by preoperative instillation of 0.5% tetracaine into the 48 eyes during horizontal strabismus muscle surgery. In all cases, recession was done first. The results were as followings: 1. The incidences of oculocardiac reflex in treated and control group were 33% and 71% respectively and the difference was statistically significant(p<0.025). 2. The reduction in the incidence of oculocardiac reflex was noted both in recession and resection. But there was no statistically significant difference between treated group and control group in resection. 3. The incidence of oculocardiac reflex was not related with age, sex, type of strabismus, kind of muscles and type of surgery.
Anesthesia* ; Anesthesia, General ; Incidence ; Muscles ; Reflex, Oculocardiac* ; Strabismus ; Tetracaine

The oculocardiac reflex was quantitatively measured in 58 patients with strabismus. The reflex was observed in some patients when the medial rectus, lateral rectus, and inferior oblique were stretched, and resultant oculocardiac reflex was analysed in quantitative manner. The results were as follows. 1. The positive oculocardiac reflex, more than 10% of heart rate decrement or arrythmia, was observed in 43.1% of tracted medial rectus muscles, 40.0% of inferior oblique muscles, and 28.0% of lateral recturs muscles. 2. The incidence of the oculocardiac reflex was increased with increasing the traction force. 3. The threshold of the oculocardiac reflex was varied from 50 to 450 gm in the medial rectus, 150 to 500 gm in the lateral rectus, and 100 to 400 gm in the inferior oblique muscles. 4. The depth of the bradicardia was 17.0% in the medial rectus, 5.9% in the lateral rectus, and 9.8% in the inferior oblique muscles by the 100 gm unit of the traction forces.
Arrhythmias, Cardiac ; Heart Rate ; Humans ; Incidence ; Muscles ; Reflex ; Reflex, Oculocardiac* ; Strabismus ; Traction

Stimulation of trigeminal nerve by traction of extraocular muscle during strabismus surgery induces various vagal symptoms such as oculocardiac reflex, nausea and vomiting. We have investigated the incidence and severity of nausea and vomiting in the patients who underwent strabismus surgery under topical anesthesia and relationship with oculocardiac reflex. Among 40 patients, 16 patients(40%) complained of moderate to very severe degree of nausea and vomiting during or after surgery, and the severity of emesis increased in proportion to frequency of oculolocardiac reflex. These results suggest that so many patients would feel discomfort after strabismus surgery under topical anesthesia, and that estimation of oculocardiac reflex will be helpful in prediction of such symptoms and in taking preventive measure in advance.
Anesthesia* ; Humans ; Incidence ; Nausea* ; Reflex ; Reflex, Oculocardiac* ; Strabismus* ; Traction ; Trigeminal Nerve ; Vomiting*

The objectives of this study were to investigate the efficacy and dose-effect relationship for glycopyrrolate in the suppression of the oculocardiac reflex, and to compare glycopyrrolate with the reported equivalent dose of atropine. Glycopyrrolate 5 and 7.5ug/kg and atropine 10 and 15ug/kg were studied in 40 paediatric patients to assess more fully the dose of glycopyrrolate required for adequate prevention of the oculocardiac reflex. The results obtained were summarized as follows: 1) The increase in the mean heart rate 5 min after the test drug was statistically significant in all of the four groups. 2) Both drugs showed a dose-related response for reduction in slowing of heart rate after rectus muscle traction. 3) There is great individual variation in response to muscle traction within each group, no group being fully protected from marked slowing in heart rate. 4) The frequency of arrhythmias with low doses of both drugs was more than in high doses with both drugs.
Anesthesia* ; Arrhythmias, Cardiac ; Atropine* ; Child* ; Glycopyrrolate* ; Heart Rate* ; Heart* ; Humans ; Reflex, Oculocardiac ; Traction

BACKGROUND: Oculocardiac reflex (OCR) and postoperative nausea/vomiting are major complications of pediatric strabismus surgery. The aim of the study was to assess, in children undergoing strabismus surgery, the incidence of OCR and postoperative emesis with a inhalational and a intravenous technique. METHODS: 44 healthy children undergoing elective strabismus surgery as inpatients were randomly allocated to four anesthetic techniques: (1) induction with propofol, maintenance with propofol infusion and 50% N2O-O2 (propofol-N2O); (2) induction with propofol and fentanyl 1 microgram/kg bolus, maintenance with propofol infusion and 50% air-O2 (propofol-fentnyl-air); (3) induction with thiopental, maintenance with enflurane and 50% N2O-O2 (enflurane-N2O); (4) induction with thiopental and fentanyl 1 microgram/kg, maintenance with enflurane and 50% air-O2 (enflurane-fentanyl-air). RESULTS: The incidence of an OCR significantly increased in the propofol-fentanyl-air group as compared to the enflurane-N2O or enflurane-fentanyl-air groups. Times to extubation were shorter in the propofol- N2O group than in the propofol-fentanyl-air or enflurane-fentanyl-air groups. Alertness scores were lower in the propofol-N2O group than in the enflurane-N2O or enflurane-fentanyl-air groups. Postanesthetic recovery scores and nausea/vomiting during the 24 hr after the operation did not show any differences among the groups. CONCLUSIONS: We concluded that children undergoing strabismus surgery anesthetized with propofolfentanyl-air had more episodes of OCR, propofol-N2O had shorter times to extubation and higher alertness scores, and the addition of N2O or fentanyl to anesthetic regimen was not associated with nausea and vomiting.
Child ; Enflurane ; Fentanyl ; Humans ; Incidence ; Inpatients ; Nausea ; Postoperative Nausea and Vomiting ; Propofol ; Reflex, Oculocardiac* ; Strabismus* ; Thiopental ; Vomiting

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.
Diplopia ; Edema ; Ethmoid Sinus ; Humans ; Male ; Nausea ; Orbit ; Reflex, Oculocardiac ; Retrospective Studies ; Vomiting

Local anesthesia in strabismus surgery allows for the evaluation of ocular alignment during the operation and enables early postoperative recovery.However, extraocular muscle traction results in decreased heart rate and discomfort for the patient. Therefore, it is our attempt to reveal the degree of of decreased heart rate during extraocular muscle traction and the patient`s pain perception. This was done prospectively on personalities of the patient, preoperative heart rate in the operating room, change of heart rate and pain perception of the patient during surgery. The statistically significant decrease in heart rate due to the ocular cardiac reflex occurs during medial rectus resection, lateral rectus recession, and leads to less satisfaction in the anxious patients. Strabismus surgery under topical anesthesia does not decrease the heart rate significantly, therefore it is relatively safe and the patient`s personality was influence on the intraoperative pain perception of the patients.
Anesthesia* ; Anesthesia, Local ; Heart Rate ; Humans ; Operating Rooms ; Pain Perception ; Prospective Studies ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction