Document Type: Case Report

Authors

Forensic Medicine and Toxicology, Lady Hardinge Medical College, New Delhi-110001, India

Abstract

Oculocardiac reflex (OCR) sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardiac arrhythmia and cardiac arrest. A 45-year-old female was undergoing an elective squint correction surgery of one eye under local anaesthesia in a private hospital in December 2013. The patient was preoperatively examined, investigated and admitted to the hospital one day prior to operation. There was no previous history of any chronic illnesses. The patient collapsed during surgery and declared dead. Doctors attempting strabismus surgery under local anaesthesia should be familiar with this phenomenon.

Keywords

Main Subjects

1. Myers EF. Anesthesiology. Oculcardiac reflex in Paediatric patients. Anesthesiology 1979; 51; 350-55.

2. Gandevia SC, McCloskey DI, Potter EK. Reflex bradycardia occurring in response to diving, nasopharyngeal stimulation, and ocular pressure. J Physiol 1978; 276: 383-94.

3. Hunsley JE, Bush GH, Jones CJ. A study of glycopyrolate and atropine in suppression of oculocardiac reflex during strabismus surgery in children. Br J Anaesth 1982; 54(4): 459-64.

4. Seo K, Takayama H, Araya Y, Miura K, Someya G. A case of sinus arrest caused by opening the mouth under general anesthesia. Anesth Prog 1994;41(1): 17-8.

5. Smith RB. Death and the oculocardiac reflex. Can J Anaesth 1994; 41(8): 760.

6. Campbell R, Rodrigo D, Cheung L. Asystole and bradycardia during maxillofacial surgery. Anesth Prog 1994: 41(1): 13-6.

7. Lang SA, VanderWal M. Death from the oculocardiac reflex. Canad J Anaesth 1994; 41(2): 161.

8. Aschner B. Ueber einen bisher noch nicht beschriebenen Reflex vom Auge auf Kreislauf and Atmung: Verschwinden des Radialispulsbei Druck auf das Auge. Wien Klin Wochenschr 1908; 21: 1529.

9. Sabena V, Posteli T. Oculocardiac reflex: electrocardiographic study. Folia Cardiol 1941; 2: 301-31.

10. Welhalf WR, Johnson DC. The oculocardiac reflex during extraocular muscle surgery. Arch Ophthalmol 1965; 73: 43.

11. Apt L, Isenberg S, Gaffney WL. The oculocardiac reflex in strabismus surgery. Am J Ophthalmol 1973; 76(4): 533-6.

12. Watcha MF, Simeon RM, White PF, Stevens JL. Effect of Propofal on the incidence of post operative vomiting after strabismus surgery in paediatric outpatients. Anesthesiology 1991; 75(2): 204-9.

13. Tramer MR, Sansonett A, Fuchs-Buder T, Rifat K. Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomized controlled trial. Acta Anaesthesiol Scand 1998; 42(1): 117-23.

14. Hahnenkamp K, Honemann CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr Anaesth 2000; 10(6): 601-8.

15. Allison CE, De Lange JJ, Koole FD, Zuurmond WW, Ros HH, van Schagen NT. A comparison of the incidence of the oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children. Anesth Analg 2000; 90(2): 306-10.

16. Karanovic N, Jukic M, Carev M, Kardum G, Dogas Z. Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide. Acta Anaesthesiol Scand 2004; 48(10): 1301-5.

17. Grover VK, Bhardwaj N, Shobana N, Grewal SP. Oculo cardiac reflex during retinal surgery using peribulbar block and nitrous oxide narcotic anaesthesia. Ophthalmic Surg Lasers 1998; 29(3): 207-12.

18. Añez C, Rodríguez-Pérez A, Morales F, Partida C. Cardiac Trigeminal reflex during compression of gasserain ganglion. Rev Esp Anestesiol Reanim 1994; 41(1): 42-3. [In Spanish]

19. Munden PM, Carter KD, Nerad JA. Oculocardiac reflex during enucleation (letter). Am J Opthalmol 1991;111(3):378-9

20. Arnold R. Oculocardiac reflex caused by contact lenses. (author reply). Ophthalmic Physiol Opt 2003; 23(6): 571-2.

21. Locke MM, Spiekermann BF, Rich GF. Trigeminovagal reflex during repair of a nasal fracture under general anesthesia. Anesth Analg 1999; 88(5): 1183-4.

22. Kwick RS. Anesthesia dysrythemias in ocular surgery. Anesthesia 1980; 33: 46.

23. Karhunen U, Cozanitis DA, Brander P. The oculocardiac reflex in adults. A dose response study of glycopyrrolate and atropine. Anaesthesia 1984;

39(6): 524-8.

24. Chisakuta AM, Mirakhur RK. Anticholinergic prophylaxis does not prevent emesis following strabismus surgery in children. Paediatr Anaesth

1995; 5(2): 97-100.

25. Arnold RW, Farah RF, Monroe G. The attenuating effect of intraglossal atropine on the oculocardiac reflex. Binocul Vis Strabismus Q 2002; 17(4): 313-8.

26. Mirakhur RK, Jones CJ, Dundee JW, Archer DB. I.m. or i.v. atropine or glycopyrrolate for the prevention of oculocardiac reflex in children undergoing squint surgery. Br J Anaesth 1982; 54(10): 1059-63.

27. Blanc VF, Hardy JF, Milot J, Jacob JL. The oculocardiac reflex: a graphic and statistical analysis in infant and children. Can Anaesth Soc J 1983; 30(4): 360-9.

28. Mirakhur RK, Shepherd WF, Jones CJ. Ventilation and the oculocardiac reflex. Prevention of oculocardiac reflex during surgery for squints: role of controlled ventilation and anticholinergic drugs. Anaesthesia 1986; 41(8): 825-8.

29. Shah TH, Samad R, Salahuddin M, Shah SH, Mufti AJ, Rahman S, Syed H. Oculocardiac refelx in Strabismus Surgery under general anesthesia. J Med Sci (Peshawar) 2013; 21(2): 84-7.

30. Safavi MR, Honarmand A. Comparative effects of different anaesthetic regimens on the oculocardiac reflex. Iran Cardiovasc Res J 2007; 1(2); 98-102.

31. Sing J, Roy S, Mukherjee P, Konar D, Hazra S. Influence of topical anesthetics on oculocardiac reflex and corneal healing in rabbits. Int J Ophthalmol 2010; 3(1): 14-8. doi: 10.3980/j.issn.2222-3959.2010.01.04

32. Baek HI, Park BC, Kim WH, Son WS. Oculocardiac

reflex during the endoscopic sinus surgery. Am J Otolaryngol 2010; 31(2): 136-8.

33. Stathopoulos P, Mezitis M, Kostakis G, Rallis G. Iatrogenic oculocardiac reflex in a patient with head injury. Cranial Maxillofacial Trauma Reconstruction 2012; 5(4): 235-38. doi: 10.1055/s-0032-1322532.

34. Yang HS, Oh DE. A case of delayed oculocardiac reflex induced by an intraorbital foreign body. Ophthal Plast Reconstr Surg 2011; 27(1): 2-4.

35. Steinmetz A, Ellenberger K, März I, Ludewig E, Oechtering G. Oculocardiac reflex in a dog caused by a choroidal melanoma with orbital extension. J Am Anim Hosp Assoc 2012; 48(1): 66-70. doi: 10.5326/JAAHA-MS-5685

36. Tramèr MR, Fuchs-Buder T, Sansonetti A, Rifat K. Low incidence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery. Can J Anaesth 1997; 44(8): 830-5.

37. Bosomworth PP, Ziegler CH, Jacoby J. The oculo-cardiac reflex in eye muscle surgery. Anesthesiology 1958; 19(1): 7-10.