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Canadian Journal of Anesthesia, Vol 30, 360-369, Copyright © 1983 by Canadian Anesthesiologists' Society

The Oculocardiac Reflex: a Graphic and Statistical Analysis in Infants and Children

VICTOR FARIA BLANC FRCP(C)1, JEAN-FRANCOIS HARDY MD1, JEAN MILOT FRCS(C)1, and JEAN-LOUIS JACOB FRCS(C)1

1 Departments of Anaesthesia and Ophthalmology, Hopital Sainte-Justine and Université de Montréal, Montreal, Québec

Address correspondence to: Victor Faria Blanc MD, Department of Anaesthesia, Hôpital Sainte-Justine, 3175 Chemin Ste-Catherine, Montréal, Québec, Canada H3T 1C5

A new method for the detection and recording of the oculocardiac reflex (OCR) is described and applied to 49 healthy infants and children (six months to nine years old) undergoing strabismus surgery under halothane anaesthesia with spontaneous ventilation. Eighty-one extraocular muscles were studied. Square wave stimuli (abrupt and sustained tractions) were definitely more reflexogenic than slow slope stimuli (very gradual, progressive and gentle tractions). Vagal escape, as well as fatigue of the OCR, are graphically documented and analysed. In this series, using well-defined and controlled tractions, the medial rectus was not more reflexogenic than the other extraocular muscles. Hypercapnia was an important adjuvant factor of the OCR. Controlled ventilation is recommended. The routine use of intravenous anticholinergic drugs is briefly discussed. Prevention of the OCR, and prophylaxis of cardiac arrhythmias during strabismus surgery, now seem to be placed on a more rational basis.

Key Words: OCULOCARDIAC REFLEX • SURGERY, strabismus • ANAESTHESIA, paediatric • VAGAL escape • ARRHYTHMIAS, cardiac • ANTICHOLINERGIC, antimuscarinic drugs • HYPERCAPNIA






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Copyright © 1983 by the Canadian Anesthesiologists' Society.