Graphical and statistical analyses of the oculocardiac reflex during a non-invasive intracranial pressure measurement

Hamarat, Yasin; Bartušis, Laimonas; Deimantavičius, Mantas; Šiaudvytytė, Lina; Janulevičienė, Ingrida; Ragauskas, Arminas; Bershad, Eric M.; Fandiño, Javier; Kienzler, Jenny; Remonda, Elke; Matijošaitis, Vaidas; Rastenytė, Daiva; Petrikonis, Kęstutis; Berškienė, Kristina; Žakelis, Rolandas

doi:10.1371/journal.pone.0196155

Cited by 4 publications

(6 citation statements)

References 27 publications

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“… 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. 22 …”

Section: Influence Of Anesthesiologistmentioning

confidence: 93%

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The Oculocardiac Reflex: A Review

Arnold¹

2021

OPTH

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Background A typical oculocardiac reflex (OCR) is a moderate trigemino-vagal bradycardia elicited by tension on an extraocular muscle (EOM) during strabismus surgery; however, many other orbital stimuli can elicit cardiac slowing including retinopathy of prematurity examination. Methods World literature related to trigeminovagal and oculocardiac reflex covering over 15,000 patients including 51 randomized clinical trials and case reports are analyzed and reviewed. Under an ongoing observational trial in Alaska, anesthetic, patient and surgical influences on routine strabismus surgery using prospective, uniform EOM tension are compared seeking sufficient sample size to characterize this individually widely variable cardiac response. Results With adequate sample size, and emphasizing clinical studies controlling type of EOM, muscle tension amount and duration, anticholinergic and opioid medications, the following augment OCR; rapid-acting opioids and dexmedetomidine while OCR is reduced in older patients, the right eye, less EOM tension, deeper inhaled agents, hypocarbia, anticholinergic medications and orbital block. In re-operations, the former are relatively poor predictors of subsequent OCR. Conclusion Profound bradycardia can occur in almost 10% of strabismus surgery cases without anticholinergic preventive measures, but reliable prediction of OCR remains elusive. With foreknowledge and careful anesthetic monitoring of the patient before EOM manipulation, residual adverse sequelae from OCR are fortunately very rare. Despite well over a century of experience, the teleology for this occasionally dramatic cardiac response to eye surgery is still not known.

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Section: Influence Of Anesthesiologistmentioning

confidence: 93%

“… 230 Hamarat et al used sophisticated ramped up globe pressure from 0 to 48 mmHg monitoring noninvasive intracranial pressure in glaucoma patients, neuro patients and normal subjects showing only 0.9% OCR (10% bradycardia) with none reaching 20% bradycardia. 220 …”

Section: Influence Of Anesthesiologistmentioning

confidence: 99%

The Oculocardiac Reflex: A Review

Arnold¹

2021

OPTH

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“…All subjects were in a supine position during the procedure. The duration of the measurement procedure was up to 10 min [17]. IOP was measured with a Goldmann applanation tonometer just before the non-invasive ICP measurement procedure.…”

Section: Methodsmentioning

confidence: 99%

“…However, a non-invasive measurement method of ICP which has clinically acceptable accuracy, precision, and diagnostic reliability can overcome this limitation [14][15][16] and can be applied to a wider range of patient groups. The method is based on the principles of a non-invasive arterial blood pressure measurement and uses two depth transcranial Doppler (TCD) ultrasonography to assess blood flow velocity of the ophthalmic artery (OA) during a gradual externally applied pressure (Pe) over a closed eyelid that is transmitted to the eye and orbital (peri-ocular) tissues [17,18].…”

Section: Introductionmentioning

confidence: 99%

Prospective Clinical Study of Non-Invasive Intracranial Pressure Measurements in Open-Angle Glaucoma Patients and Healthy Subjects

et al. 2020

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Background and Objective: Glaucoma is a progressive optic neuropathy in which the optic nerve is damaged. The optic nerve is exposed not only to intraocular pressure (IOP) in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Here, we analyse ICP differences between patients with glaucoma and healthy subjects (HSs). Materials and Methods: Ninety-five patients with normal-tension glaucoma (NTG), 60 patients with high-tension glaucoma (HTG), and 62 HSs were included in the prospective clinical study, and ICP was measured non-invasively by two-depth transcranial Doppler (TCD). Results: The mean ICP of NTG patients (9.42 ± 2.83 mmHg) was significantly lower than that of HSs (10.73 ± 2.16 mmHg) (p = 0.007). The mean ICP of HTG patients (8.11 ± 2.68 mmHg) was significantly lower than that of NTG patients (9.42 ± 2.83 mmHg) (p = 0.008) and significantly lower than that of HSs (10.73 ± 2.16 mmHg) (p < 0.001). Conclusions: An abnormal ICP value could be one of the many influential factors in the optic nerve degeneration of NTG patients and should be considered as such instead of just being regarded as a “low ICP”.

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“…If the optic canal or the optic canal foramen is blocked by suprasellar meningioma, annular adhesion after tuberculous meningitis, or aneurysm of the optic canal, the accurate ICP value cannot be measured (71). Because of putting pressure on the eyeball, this method is not suitable for patients with ocular trauma, and it also needs to pay attention to the risk of oculocardiac reflex (72). Oculocardiac reflex is the eyeball is mechanically stimulated when the eyeball is removed, compressed, or the eye muscle is stretched, which causes the vagus nerve to be overexcited, leading to arrhythmia, the slower pulse.…”

Section: Two-depth Transcranial Doppler (Td-tcd)mentioning

confidence: 99%

Non-invasive detection of intracranial pressure related to the optic nerve

Li¹,

Wan²

2021

Quant Imaging Med Surg

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Intracranial pressure (ICP) is associated with a variety of diseases. Early diagnosis and the timely intervention of elevated ICP are effective means to clinically reduce the morbidity and mortality of some diseases. The detection and judgment of reduced ICP are beneficial to glaucoma doctor and neuro ophthalmologist to diagnose optic nerve disease earlier. It is important to evaluate and monitor ICP clinically.Although invasive ICP detection is the gold standard, it can have complications. Most non-invasive ICP tests are related to the optic nerve and surrounding tissues due to their anatomical characteristics. Ultrasound, magnetic resonance imaging, transcranial Doppler, papilledema on optical coherence tomography, visual evoked potential, ophthalmodynamometry, the assessment of spontaneous retinal venous pulsations, and eye-tracking have potential for application. Although none of these methods can completely replace invasive technology; however, its repeatable, low risk, high accuracy, gradually attracted people's attention. This review summarizes the non-invasive ICP detection methods related to the optic nerve and the role of the diagnosis and prognosis of neurological disorders and glaucoma. We discuss the advantages and challenges and predict possible areas of development in the future.

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Graphical and statistical analyses of the oculocardiac reflex during a non-invasive intracranial pressure measurement

Cited by 4 publications

References 27 publications

The Oculocardiac Reflex: A Review

The Oculocardiac Reflex: A Review

Prospective Clinical Study of Non-Invasive Intracranial Pressure Measurements in Open-Angle Glaucoma Patients and Healthy Subjects

Non-invasive detection of intracranial pressure related to the optic nerve

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