&lt;p&gt;Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?&lt;/p&gt;

Arnold, Robert W.; Bond, Aleah N

doi:10.2147/opth.s230498

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…We also have documented that topical anesthetic do not enhance recovery from strabismus surgery, but maybe actually worsen recovery in young patients. 17 Not every effort to reduce exam pain is benign. 13 Ongoing close monitoring is also indicated due to an increased frequency of cardiorespiratory events in the hours after the exam.…”

Section: Discussionmentioning

confidence: 99%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/XB2uu1ca7kQ Purpose: Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. Patients and Methods: Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. Results: From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness −1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA)-11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34-240 seconds). Conclusion: Bradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

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Section: Discussionmentioning

confidence: 99%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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“…A more recent study, in which 60 patients from different age groups following strabismus surgery were treated with proparacaine and 80 control patients were not so treated, determined in general no effect on postoperative pain and PONV [15]. Interestingly, a subgroup analysis revealed a pronounced negative effect in patients younger than 3.5 years, an age at which operations are traditionally rarely performed in Germany.…”

Section: Discussionmentioning

confidence: 98%

Postoperative Behaviour after Primary Strabismus Surgery in Children: Is There an Influence of Intraoperative Topical Anaesthesia?

Karstädt

Crozier

Horn

et al. 2020

Klin Monbl Augenheilkd

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Introduction The course of the recovery phase after general anaesthesia, during which consciousness and pain gradually return, is essentially determined by the choice of anaesthetic drug, and its total dose or duration of application. This phase is often complicated by more or less severe agitation, especially in children. In the present study we investigated whether the application of a topical anaesthetic to the conjunctiva at the end of a strabismus operation had a positive effect on the recovery behaviour of the child. Patients/Methods This prospective, randomised, blinded study was conducted with 50 healthy, ASA class I or II children, aged 3 to 8 years undergoing their first strabismus operation. Following the surgeonʼs randomisation two drops of a 0,5% tetracaine-HCl ophthalmic solution were applied to the operated conjunctiva three times at 30-s intervals immediately following wound closure. The postoperative evaluation encompassed heart rate, as well as COMFORT and CHEOPS scores. The first assessment was directly postoperatively with repetitions at 15, 30, 45, 60, 75, 90 and 120 min, as well as on the day after surgery. Results The CHEOPS scores did not differ significantly between children with or without topical anaesthesia at any time during the observation period. The COMFORT scores revealed a slight, but non-significant analgesic effect at 15 and 30 min. The 60 min score showed the opposite effect, possibly indicating a slight disadvantage of the topical anaesthesia. There were no significant differences with regard to time to first request for additional systemic analgesia, to the total dose of systemic pain medication, or to when the patient was eligible for discharge to the ward. Conclusion The application of topical tetracaine-HCl immediately after wound closure had no positive effects on the course of the postoperative recovery period after strabismus surgery in children. There was no evidence of an effect on pain or emergence agitation.

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“…163 Song et al utilized a single experienced senior surgeon presumed to deliver “comparable EOM tension.” 20 A uniform 200 gram, 10-second square wave tension has been used in the Alaska OCR study. 19 , 22 , 38 , 100 , 110 , 125 , 131 , 159 , 164 Machida found OCR −18% with 400 gram, −16% with 200 gram but significantly less −10% for 50 gram tension. 165…”

Section: Influence Of Anesthesiologistmentioning

confidence: 95%

“… 5 , 20 , 23 , 24 , 39 , 70–85 Figure 5 shows the frequency distribution and cumulative prevalence of %OCR for the Alaska OCR project compared to cases defined as more than 10% or 20% heart rate drop. Profound OCR can be defined as greater than 33% 86 or a 50% decrease in heart rate. 22 Rahimi Varposhti et al go further by defining “mild” OCR as 20%-30% HR drop, “moderate” OCR as 30% to 40% drop and “severe” as greater than 40% heart rate drop.…”

Section: Influence Of Anesthesiologistmentioning

confidence: 99%

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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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<p>Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?</p>

Cited by 4 publications

References 16 publications

<p>Oculocardiac Reflex During ROP Exams</p>

<p>Oculocardiac Reflex During ROP Exams</p>

Postoperative Behaviour after Primary Strabismus Surgery in Children: Is There an Influence of Intraoperative Topical Anaesthesia?

The Oculocardiac Reflex: A Review

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