Peribulbar block or topical application of local anaesthesia combined for paediatric strabismus surgery

Trigeminocardiac reflex in the Postanesthesia care unit

“…Administration of IV anticholinergics also may be considered; however, TCR refractory to atropine administration may occur, and, in these cases, small bolus doses of epinephrine may be required [12,13]. A safety precaution also could be placement of temporary pacemaker pads on the patient before the stimulus [14].…”

Management of the Trigeminocardiac Reflex

“…71 retinal detachment significantly reduced the incidence, and attenuated the severity, of the reflex. 58,63 In comparison to the application of a topical local anesthetic in children undergoing strabismus surgery, peribulbar block was an efficacious prophylaxis in preventing the reflex. 58 Misurya et al studied the effectiveness of peripheral cardiac muscarinic receptor blockade using intravenous atropine sulfate versus conduction of the afferent limb at the ciliary ganglion with retrobulbarxylocaine hydrochloride.…”

The Oculocardiac Reflex

“…In pediatric strabismus surgery, the incidence of bradycardia decreased from 94% to 13% when regional anesthesia was added to general anesthesia alone. [30][31][32][33][34] A word of caution, however, is in order regarding the use of retro orbital block: the procedure can lead to hematomas, causing a rise in intraocular pressure, and can itself be a risk factor for the OCR. [24][25][26][27][28][29][30] Anticholinergic prophylaxis has also been found to decrease the incidence of the OCR.…”