EVALUATION OF THE EFFECT OF OCULOCARDIAC REFLEX ON THE HEART RATE IN NON-ATROPINIZED PATIENTS DURING CATARACT SURGERY UNDER LOCAL ANAESTHESIA
Basrah Journal of Surgery,
2014, Volume 20, Issue 2, Pages 41-45
AbstractOculocardiac reflex (OCR) is an event seen during the cataract operation revealed as bradycardia. The situation is triggered by pulling or stitching of external ocular muscles. Anesthesiologists used atropine for controlling this reflex if ensues.
This study aimed to estimate the incidence of the oculocardiac reflex during cataract surgery under local anesthesia (LA) and to assess the need for atropine to avoid this event.
This study included eighty patients aged 45-80 years with class I or II ASA physical status listed for elective cataract extraction and intraocular lens (IOL) implantation under peribulbar block. The past medical history, drugs history, investigations and baseline vital signs were all observed and recorded. The observer continuously monitors heart rate readings. Oxygen was given to all patients through nasal cannula while spontaneously breathing.
The results showed a significant drop in the heart rate following superior rectus muscle grasp and stitching (5.69%). This finding was observed following sedation (6.19%) and after removing of the stitch (6.22%), which indicates triggering of OCR. This slowing in heart rate did not require the use of atropine as bradycardia did not reach a serious level.
In conclusion, the alterations in heart rate during cataract surgery observed mainly at handling of the extra-ocular muscles and following sedation. Atropine is not essential as a routine premedication in cataract surgery, particularly in geriatric populations in order to avoid the major side effects of atropine such as: tachyarrhythmias, central nervous system toxicity and urine retention, however, it should be accessible for administration if bradycardia ensues.
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