Adjustment in patients with asystole during strabismus surgery

Abstract

Purpose To investigate whether patients who developed asystole during strabismus surgery under general anesthesia also develop asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients. Design Retrospective, noncomparative interventional case series.Methods Adjustment was performed with topical anesthesia in four patients aged 28, 32, 50, and 53 years who exhibited asystole during strabismus surgery under general anesthesia. Blood pressure and electrocardiogram were monitored during the adjustment. Results Adjustment was successfully completed in all patients without asystole. Two patients showed oculocardiac reflex (OCR), with a reduction in heart rate (HR) >20% of the baseline value. One of these patients exhibited severe OCR that developed when the patient's posture was changed from the supine to the sitting position for measurement of the angle of strabismus after adjustment, and again during conjunctival manipulation after conjunctival closure. No patient required atropine. Conclusions Adjustment can safely be performed under topical anesthesia in patients who developed asystole during strabismus surgery under general anesthesia.

The Oculocardiac Reflex: A Review

“… 75 Severe OCR was seen in 1 of 4 patients with conjunctival closure under topical anesthesia. 158 Kim and Shin found OCR (15% bradycardia) of 7% with conjunctival manipulation compared to unquantified muscle traction of 38%. 69 Rahimi et al described “the incision phase” which may include conjunctival and Tenon’s capsule dissection which had 16% incidence compared to greater 27% incidence during the “release phase” described as muscle manipulation.…”

“… 155 Of 4 adults with “asystole” during initial EOM surgery, subsequent adjustment cases resulted in two with >20% OCR and one with severe OCR sitting up for adjustment and with conjunctival closure. 158 …”

“…110 One of 4 patients with recent asystole OCR had severe OCR on subsequent adjustment. 158 Neurologic patients including traumatic brain injury and glaucoma patients were not additionally prone to globe pressure OCR. 220 Of 9% with profound 50% OCR, those with re-operation were more likely (38%) to repeat with profound OCR.…”