Oculocardiac Reflex as a Late Presentation of Orbital Floor Fracture

Başağaoğlu, Berkay; Steinberg, Ashley; Tung, Irene T.; Olorunnipa, Shola; Maricevich, Renata S.

doi:10.1097/scs.0000000000004966

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Traction applied especially on the rectus medialis has been associated with the occurrence of OCR (17). Multiple studies have reported an increased incidence of OCR with medial rectus traction compared to other ocular muscles (18,19). Similarly, in our study the right and left rectus medialis were the most common muscle in which OCR occurred by 77%.…”

Section: Discussionsupporting

confidence: 80%

Hydroxyzine dihydrochloride premedication is a necessity for pediatric patients undergoing strabismus surgery: An observational prospective clinical trial

Kartufan

Kızılcık

Ziylan

et al. 2022

Preprint

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Objective: In this single-blind, observational prospective trial we aimed to determine and compare the effect of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of Oculocardiac Reflex (OCR).Methods: Forty-five patients divided into three groups retrospectively after surgery; according to the oral premedication before surgerys. Group M received 0.5mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The observational part of the study was carried out prospectively during surgery. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups. Results: The mean HR1, HR2 and HR3 values were significantly increased (p=0.002, p<0.001, p<,0.001) and the incidence of OCR (p=0.004) was significantly decreased in the Group H, and in the Group HM (for all, p<0.01) compared to the Group M. No statistically significant difference was found between the Group H and Group HM in terms of RSS, HR1, HR2, HR3 and the incidence of OCR (for all, p>0.05). The most common orbital muscle in which OCR occurred was the rectus medialis. Conclusion: Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to the premedication with midazolam alone.

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Section: Discussionsupporting

confidence: 80%

Hydroxyzine dihydrochloride premedication is a necessity for pediatric patients undergoing strabismus surgery: An observational prospective clinical trial

Kartufan

Kızılcık

Ziylan

et al. 2022

Preprint

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show abstract

“…Traction applied especially on the rectus medialis has been associated with the occurrence of OCR [ 17 ]. Multiple studies have reported an increased incidence of OCR with medial rectus traction compared to other ocular muscles [ 18 , 19 ]. Similarly, in our study, the right and left rectus medialis were the most common muscles in which OCR occurred by 77%.…”

Section: Discussionmentioning

confidence: 99%

Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial

Kartufan¹,

Kızılcık

Ziylan

et al. 2022

Journal of Ophthalmology

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Objective. In this single-blind, observational prospective clinical trial, we aimed to determine and compare the effects of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of oculocardiac reflex (OCR). Methods. Forty-five patients were divided into three groups. Group M received 0.5 mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1 mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR, and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups. Results. The mean HR1, HR2, and HR3 values were significantly increased ( p = 0.002 , p < 0.001 , p < 0.001 ) and the incidence of OCR ( p = 0.004 ) was significantly decreased in Group H and in Group HM (for all, p < 0.01 ) compared to Group M. The most common orbital muscle in which OCR occurred was the rectus medialis. Conclusion. Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to premedication with midazolam alone. This study was registered on https://clinicaltrials.gov/ with number NCT03806270.

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“… 199 Bradycardia may occur late after orbital floor fracture. 200 Manipulation of the temporalis muscle during orbitozygomatic craniotomy produced reproducible, consistent asystole. 201 …”

Section: Influence Of Anesthesiologistmentioning

confidence: 98%

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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Oculocardiac Reflex as a Late Presentation of Orbital Floor Fracture

Cited by 8 publications

References 14 publications

Hydroxyzine dihydrochloride premedication is a necessity for pediatric patients undergoing strabismus surgery: An observational prospective clinical trial

Hydroxyzine dihydrochloride premedication is a necessity for pediatric patients undergoing strabismus surgery: An observational prospective clinical trial

Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial

The Oculocardiac Reflex: A Review

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