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Oculocardiac reflex during routine strabismus surgery was prospectively observed in association with routine brain wave monitoring.
Providence Hospital institutional review board (IRB) approved this observational study without need for consent.
Introduction: The oculocardiac reflex (OCR), bradycardia that occurs during strabismus surgery, is blocked by anticholinergics and enhanced by opioids and dexmedetomidine. Two recent studies suggest that deeper inhalational anesthesia monitored by bispectral index (BIS) protects against OCR; the investigators wondered if our data correlated similarly.
Methods: In an ongoing, prospective study of OCR elicited by 10-second, 200 gram square-wave traction on extraocular muscles (EOM) from 2009 to 2013, anesthetic depth was estimated in cohorts using either BIS or Narcotrend monitors. The depth of anesthesia was deliberately varied between first and second EOM tested.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BIS | Monitored with BIS (bispectral index) monitor in addition to other conventional monitors of blood pressure, ECG, oxygen saturation and anesthetic agent concentration. |
| |
| Narcotrend | Monitored with Narcotrend monitor in addition to other conventional monitors of blood pressure, ECG, oxygen saturation and anesthetic agent concentration. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| non-invasive monitor | Device | cutaneous EEG monitor |
|
| Measure | Description | Time Frame |
|---|---|---|
| heart rate change | bradycardia with extra ocular muscle tension | intraoperative 10 seconds |
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Inclusion Criteria:
Exclusion Criteria:
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strabismus surgery
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| Name | Affiliation | Role |
|---|---|---|
| Robert W Arnold, MD | Alaska Childrens EYE & Strabismus | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29733898 | Background | Arnold RW, Biggs RE, Beerle BJ. Intravenous dexmedetomidine augments the oculocardiac reflex. J AAPOS. 2018 Jun;22(3):211-213.e1. doi: 10.1016/j.jaapos.2018.01.016. Epub 2018 May 5. | |
| 30871507 | Background | Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol. 2019 Mar 14;19(1):36. doi: 10.1186/s12871-019-0712-z. |
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de-identified data base stored.
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| ID | Term |
|---|---|
| D001919 | Bradycardia |
| D013285 | Strabismus |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
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| ID | Term |
|---|---|
| D058256 | Brain Waves |
| ID | Term |
|---|---|
| D004569 | Electroencephalography |
| D003943 | Diagnostic Techniques, Neurological |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D015835 | Ocular Motility Disorders |
| D003389 | Cranial Nerve Diseases |
| D009422 | Nervous System Diseases |
| D005128 | Eye Diseases |
| D004568 | Electrodiagnosis |
| D055724 | Electrophysiological Phenomena |
| D010829 | Physiological Phenomena |
| D009424 | Nervous System Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |