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Orbit
Published in Swati Goyal, Neuroradiology, 2020
Enophthalmos, orbital restriction, strabismus, and diplopia, especially on vertical gaze. Entrapment of the inferior rectus muscle results in oculocardiac reflex, especially in the pediatric population, with a triad of bradycardia, nausea, and syncope.
Dosage of Eye Muscle Surgery in Endocrine Orbitopathy
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
K.-P. Boergen, G. Rudolph, O. Ehrt, P. Kalpadakis
The manipulation on the eye muscle under topical anaesthesia is very well tolerated by the patient. The oculo-cardiac reflex is absent so that no bradycardia or even heart arrest disturbs the patient and the surgeon.
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
Oculocardiac reflex occurs during manipulation of the eye, especially the extraocular muscle during strabismus or retinal surgery. Both the heart rate and blood pressure drop when this happens. The use of peribulbar anaesthesia reduces the transmission of nerve impulses from the eye and therefore dampens the reflex. The use of atropine prevents bradycardia and is used to abolish the reflex. Other measures mentioned are ineffective.
The effect of adding magnesium sulphate as an adjuvant to peribulbar block for glaucoma surgery in morbidly obese patients: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Norhan A. Sherif, Noha A. Osama, Iman S. Aboul Fetouh, Mayada K. Mohamad
The oculocardiac reflex (OCR) is a complication that may occur during any ophthalmic surgery involving the orbit due to pressure on the eye globe, conjunctiva, or other orbital structures and traction on the extraocular muscles. The reflex causes bradycardia and hypotension, with potentially serious, life-threatening consequences. Monitoring and assessment of heart rate and blood pressure are mandatory to manage OCR [22]. The stability of heart rate and blood pressure indicates the non-occurrence of OCR in either group. This protective effect of MS against OCR was also stated by Sherif et al. [16] who found that none of the patients suffered this reflex in the 100 mg-MS group compared to 33.3% of patients in the standard technique group (p = 0.002). Such an effect of MS may be the result of deep anesthesia and analgesia [23].
Subtenon versus intravenous Dexmedetomidine injection for postoperative analgesia in infantile cataract surgery: double-blind randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2020
Wesam Nashat Ali, Jehan Ahmed Sayed, Maram M. Amir, Mohamed Omar M Aly, Marwa Mahmoud Abdel-Rady, Emad Zarief Kamel
Upon the arrival of patients into the operating room, anesthesia was induced with an 8% concentration of sevoflurane in 100% oxygen using a face mask with infant T-piece anesthesia circuit under the monitoring of ECG, pulse oximetry (Spo2), and noninvasive blood pressure (NIBP). A 22-G cannula was inserted and normal saline of 3 ml/kg/h was infused after induction of anesthesia. After insertion of the laryngeal mask airway (size 2–2.5), sevoflurane concentration (1–2%) in 100% oxygen (SPO2 goal >95%). Respiratory parameters were monitored (goals; End-tidal CO2 partial pressure (ETCO2) of 40–45 mm Hg, tidal volume of 7.0–10 ml/kg, and a respiratory rate of 20–25 breath/min). Ventilation was assisted in case of apnea/hypopnea or if the infant’s ETCO2 > 50 mmHg. Interventions were done just after induction, and surgery was started 5 minutes after study drug administration. At the end of the surgery, sevoflurane inhalation was stopped the laryngeal mask airway was removed. Intraoperatively, oculocardiac reflex (OCR) was defined as a sudden decrease in heart rate by more than 20%, or any arrhythmia during surgery. Fentanyl 0.5 ug/kg was administrated if the patient’s heart rate or blood pressure increased by ≥20% during surgery, and the infant was excluded from the study.
Management of pediatric orbital wall fractures
Published in Expert Review of Ophthalmology, 2019
Two common presentations of trapdoor fractures in children are the oculocardiac reflex and the white-eyed blowout fracture (Figures 1 and 2). The oculocardiac reflex is the triad of symptoms (nausea/vomiting, bradycardia, and syncope) that results from communication between the ophthalmic division of the trigeminal nerve and the visceral motor nucleus of the vagus nerve via the reticular formation. This symptomatology has been reported as highly suggestive of inferior rectus or orbital soft-tissue entrapment in the setting of known periocular trauma and can be considered an indication for immediate surgery [21,31,40]. An average of one in four children with serious entrapment requiring surgery will present with nausea and vomiting (range: 14.7–55.6%) as well as restricted extraocular motility [16,17,19,21]. The presence of nausea and vomiting has been reported to have a positive predictive value of 75% for a trapdoor fracture [35]. Furthermore, nausea and vomiting had a reported positive predictive value of 83.3% for inferior rectus entrapment in the presence of a documented trapdoor fracture [35].