Setting up a heart rate alarm limit to decrease oculocardiac reflex during strabismus surgery in children

Abstract

The aim of this paper is to investigate a method which may decrease the incidence and severity of oculocardiac reflex (OCR) without drugs. One hundred and sixty children undergoing strabismus surgery were allocated to two groups using double-blind randomization. OCR was defined as a decrease of more than 10% from the baseline heart rate during operation. An alarm sounded and a lamp flashed as soon as OCR occurred in group I, and neither of the above happened in group II. OCR occurred (1.151 ± 0.858) times in group I and (2.287 ± 1.371) times in group II (P < 0.05). Heart rate decreased by (23 ± 19) bpm in group I and (35 ± 28) bpm in group II (P < 0.05). The duration of OCR in group I and group II was (4.36 ± 4.26)s and (7.62 ± 6.41)s, respectively (P < 0.05). The recovery time for group I and group II was (15.36 ± 13.28)s and (32.36 ± 19.57)s, respectively (P < 0.05). The numbers of times of interruption were 8 in group I (10%) and 26 in group II (32%) (P < 0.01). This method significantly decreased the incidence and severity of OCR during strabismus surgery in children.

References

1. Liu G Z, Zu Y . Prevention and remedy ofoculocardiac reflex. Zhong Yuan Yi Kan, 2006, 33(4): 51–54 (in Chinese)
2. Gu E H .Clinical analysis about oculocardiac reflex in fossa orbitalis surgery. Zhonghua Yan Ke Za Zhi, 1996, 4(2): 249(in Chinese)
3. Dong Z, Sun J N . Ophthalmologic operationand oculocardiac reflex. Dong Nan Da XueXue Bao (Med Sci Ed), 2007, 26(2): 148–151 (in Chinese)
4. Yi F, Yu J P, Cai M J, Zeng J J . Initial Discussionabout oculocardiac reflex in construction of double eyelid.Zhongguo Shi Yong Mei Rong Zheng Xing Wai Ke ZaZhi, 2004, 15(4): 191–193 (in Chinese)
5. Zhuge W Y, Ma Y, Zhao T L . Oculocardiac reflex in strabismus surgery. Zhongguo Xin Xue Guan Za Zhi, 2001, 6: 170–171 (in Chinese)
6. Karanovic N, Jukic M, Carev M, Kardum G, Dogas Z . Rocuronium attenuates oculocardiac reflexduring squint surgery in children anesthetized with halothane andnitrous oxide. Acta Anaesthesiol Scand, 2004, 48(10): 1301–1305. doi:10.1111/j.1399‐6576.2004.00523.x
7. Kim W O, Kil H K, Lee J S, Lee J H . Predictionof oculocardiac reflex in strabismus surgery using neutral networks. Yonsei Med J, 1999, 40(3): 244–247
8. Tong Y L, Sun M, Li Q, Xia J Y .Comparisonabout pulse rate when sleeping or occuring oculocardiac reflex inchildren undergoing strabismus surgery. Zhonghua Ma Zui Xue Za Zhi, 2006, 26(1): 80–81 (in Chinese)
9. Wolf G L . Complications of ophthalmologic anesthesia. Seminars in Anesthesia, 1990, 9(2): 108
10. Cai C H, Zhang W X . Re-evaluate atropine as premedicantbefore surgery. Guo Wai Yi Xue Ma Zui YuFu Su Fen Ce, 1999, 20(4): 196–199 (in Chinese)
11. Yan Z S, Yao D W, Ma J Z . Observation of oculocardiac reflex in 62 strabismus surgeries. Zhongguo Xie Shi Yu Xiao Er Yan Ke Za Zhi, 1995, 3: 70–72 (in Chinese)
12. Hahnenkamp K, Hönemann C W, Fischer L G, Durieux M E, Muehlendyck H, Braun U . Effect of different anaesthesia regimes on the oculocardiacreflex during paediatric strabismus surgery. Paediatr Anesth, 2000, 10(6): 601–608
13. Xue R X . Ketamine and peribulbar block applied on children undergoing strabismussurgery. Zhongguo Mei Tan Gong Ye Yi XueZa Zhi, 2004, 7(20): 176–177 (in Chinese)
14. Choi S H, Le e S J, Kim S H, Kim J H, Kwon H H, Shin Y S, Lee K Y . Single bolus f intravenousketamine for anesthetic induction decreases oculocardiac reflex inchildren undergoing strabismus surgery. Acta Anaesthesiol Scand, 2007, 51: 759–762. doi:10.1111/j.1399‐6576.2007.01329.x
15. Ruta U, Gerding H, Mollhoff T . Effect of locally applied lidocaine on expression ofthe oculocardiac reflex.Ophthalmology, 1997, 94(5): 354–359. doi:10.1007/s003470050128
16. Grover V K, Bhardwaj N, Shobana N, Grewal S P . Oculocardiacreflex during retinal surgery using peribulbar block and nitrous narcoticanesthesia. Ophthalmic Surg Lasers, 1998, 29(3): 207–212
17. Deb K, Subramaniam R, Dehran M, Tandon R, Shende D . Safety and efficacy of peribulbar blockas adjunct to general anaesthesia for paediatric ophthalmic surgery. Paediatr Anaesth, 2001, 11(2): 161–167. doi:10.1046/j.1460‐9592.2001.00623.x
18. Steib A, Karcenty A, Calache E, Franckhauser J, Dupeyron J P, Speeg-Schatz C . Effects of subtenon anesthesia combined with generalanesthesia on perioperative analgesic requirements in pediatric strabismussurgery. Reg Anesth Pain Med, 2005, 30(5): 478–483. doi:10.1016/j.rapm.2005.04.011
19. Gupta N, Kumar R, Kumar S, Sehgal R, Sharma K R . A prospective randomised double blindstudy to evaluate the effect of peribulbar block or topical applicationof local anaesthesia combined with general anaesthesia on intra-operativeand postoperative complications during paediatric strabismus surgery. Anaesthesia, 2007, 62(11): 1110–1113. doi:10.1111/j.1365‐2044.2007.05220.x
20. Ghai B, Makkar J K, Arora S . Introperative cardiac arrest because of oculocardiacreflex and subsequent pulmonary edema in a patient with extraocularcysticercosis. Paediatr Anesth, 2006, 16(11): 1194–1195