The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery

Robert W Arnold,1 Ainsley R Rinner,2 Andrew W Arnold,3 Brion J Beerle4 1The Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 2Grace Christian School, Anchorage, AK, USA; 3Pacific Northwest University College of Osteopathic Medicine, Yakima, WA,...

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Autores principales:	Arnold RW, Rinner AR, Arnold AW, Beerle BJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	trigemino-vagal reflex reoperation race opioid strabismus surgery bradycardia Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/2adf3a0496b14666a07ca1b86d6e1876
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spelling	oai:doaj.org-article:2adf3a0496b14666a07ca1b86d6e18762021-12-02T15:16:30ZThe Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery1177-5483https://doaj.org/article/2adf3a0496b14666a07ca1b86d6e18762020-12-01T00:00:00Zhttps://www.dovepress.com/the-impact-of-re-operation-relatives-and-race-on-the-oculocardiac-refl-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Robert W Arnold,1 Ainsley R Rinner,2 Andrew W Arnold,3 Brion J Beerle4 1The Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 2Grace Christian School, Anchorage, AK, USA; 3Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 4Chugach Anesthesia Group, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561-1917Fax +1 907 563-5373Email eyedoc@alaska.netPurpose: The oculocardiac reflex (OCR) is a trigeminovagal bradycardia elicited by tension on an extraocular muscle (EOM). Using three decades of observational data, we investigated whether or not individual strabismus patients are prone to oculocardiac reflex.Patients and Methods: All patients undergoing strabismus surgery from 1992 to 2019 had deliberate 10-second, 200-gram square-wave tension on extraocular rectus muscles with anesthetic variables recorded. OCR was defined as the maximally tension-altered heart rate as a percent of stable baseline heart rate.Results: OCR was compared in 2532 original cases with 323 re-operations. The 169 cases that used anticholinergics (99% OCR) were excluded from the analysis. The median OCR, a 15% drop, was found to be 85% (95% CI 39%, 102%,; range 5– 151%). Factors that showed a significant effect on the OCR were the type of EOM with lateral rectus least (Kruskal–Wallis X2(3)=8, p< 0.05), and adults had less OCR compared to the children (X2(2)=105, p< 0.01). Factors that showed an augmenting effect on the OCR were peri-operative opioids (X2(6)=62, p< 0.01) and Caucasian race (X2(4)=12, p< 0.02). Gender and iris color were not found to have an impact on OCR. Re-operations and first-degree relatives did not differ from age-matched controls, but EOM- and opioid-adjusted re-operations correlated with their initial cases (r=0.37).Conclusion: We confirmed the previously published blocking effect of atropine, augmenting impact of opioids, and an inverse relationship of age on OCR. There was a weak proclivity for individuals to be prone to OCR. We found an impact of race with Caucasians having more OCR.Keywords: trigemino-vagal reflex, re-operation, race, opioid, strabismus surgery, bradycardiaArnold RWRinner ARArnold AWBeerle BJDove Medical Pressarticletrigemino-vagal reflexreoperationraceopioidstrabismus surgerybradycardiaOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 4253-4261 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	trigemino-vagal reflex reoperation race opioid strabismus surgery bradycardia Ophthalmology RE1-994
spellingShingle	trigemino-vagal reflex reoperation race opioid strabismus surgery bradycardia Ophthalmology RE1-994 Arnold RW Rinner AR Arnold AW Beerle BJ The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
description	Robert W Arnold,1 Ainsley R Rinner,2 Andrew W Arnold,3 Brion J Beerle4 1The Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 2Grace Christian School, Anchorage, AK, USA; 3Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 4Chugach Anesthesia Group, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561-1917Fax +1 907 563-5373Email eyedoc@alaska.netPurpose: The oculocardiac reflex (OCR) is a trigeminovagal bradycardia elicited by tension on an extraocular muscle (EOM). Using three decades of observational data, we investigated whether or not individual strabismus patients are prone to oculocardiac reflex.Patients and Methods: All patients undergoing strabismus surgery from 1992 to 2019 had deliberate 10-second, 200-gram square-wave tension on extraocular rectus muscles with anesthetic variables recorded. OCR was defined as the maximally tension-altered heart rate as a percent of stable baseline heart rate.Results: OCR was compared in 2532 original cases with 323 re-operations. The 169 cases that used anticholinergics (99% OCR) were excluded from the analysis. The median OCR, a 15% drop, was found to be 85% (95% CI 39%, 102%,; range 5– 151%). Factors that showed a significant effect on the OCR were the type of EOM with lateral rectus least (Kruskal–Wallis X2(3)=8, p< 0.05), and adults had less OCR compared to the children (X2(2)=105, p< 0.01). Factors that showed an augmenting effect on the OCR were peri-operative opioids (X2(6)=62, p< 0.01) and Caucasian race (X2(4)=12, p< 0.02). Gender and iris color were not found to have an impact on OCR. Re-operations and first-degree relatives did not differ from age-matched controls, but EOM- and opioid-adjusted re-operations correlated with their initial cases (r=0.37).Conclusion: We confirmed the previously published blocking effect of atropine, augmenting impact of opioids, and an inverse relationship of age on OCR. There was a weak proclivity for individuals to be prone to OCR. We found an impact of race with Caucasians having more OCR.Keywords: trigemino-vagal reflex, re-operation, race, opioid, strabismus surgery, bradycardia
format	article
author	Arnold RW Rinner AR Arnold AW Beerle BJ
author_facet	Arnold RW Rinner AR Arnold AW Beerle BJ
author_sort	Arnold RW
title	The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
title_short	The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
title_full	The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
title_fullStr	The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
title_full_unstemmed	The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery
title_sort	impact of re-operation, relatives and race on the oculocardiac reflex during strabismus surgery
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/2adf3a0496b14666a07ca1b86d6e1876
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The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery

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