The Effect of Tetracaine Eyedrop versus Placebo on Oculocardiac Reflex in Strabismus Surgery

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Resident, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Strabismus surgery is accompanied with manipulation of intraocular structures that may lead to oculocardiac reflex (OCR). Due to possible perilous effects of oculocardiac reflex, this study aimed to assess the effects of tetracaine eyedrop as a local nerve impulse cutter on oculocardiac reflex in strabismus surgery.Methods: This clinical-trial study included 70 patients undergone strabismus surgery. They were randomly divided in two groups of placebo (artificial tear) and tetracaine. Immediately after anesthesia and prior to any surgical procedure, three drops of each solution were dropped in four direction of patients' eye. For all patients, heart rate (HR), systolic blood pressure (SBP),diastiloc blood pressure (DBP), mean arterial pressure (MAP), and pulse rate (RR) were assessed in various times. Incidence (20% decrease in heart rate) and severity (mild, moderate, and severe) of oculocardiac reflex in muscle release and cutting, required time for oculocardiac reflex recovery, and atropine dose were compared.Findings: Incidence of oculocardiac reflex was not different in two groups in release phase (8 and 11 in tetracaine and placebo groups, respectively; P = 0.42); but it was significantly more in cutting phase (2 and 9 in tetracaine and placebo groups, respectively; P = 0.02). Oculocardiac reflex severity was not different in release phase between the two groups (mild: 5, moderate: 2, and severe: 1 in tetracaine, and mild: 8, moderate: 0, and severe: 3 in placebo group; P = 0.44), but was more in placebo group (mild: 1, moderate: 1, and severe: 0 in tetracaine, and mild: 1, moderate: 8, and severe: 0 in placebo group; P = 0.02). Duration of oculocardiac reflex recovery (P = 0.74) and used atropine dose (P = 0.92) were not different between the two groups.Conclusion: Using local tetracaine eyedrop could merely decrease incidence and severity of oculocardiac reflex in cutting phase of strabismus surgery. For definitive comments, further studies are recommended.

Keywords

References

  1. Allman K, Wilson I, O'Donnell A. Oxford handbook of anaesthesia. Oxford, UK: Oxford University Press; 2016.
  2. Talebnejad MR, Khademi S, Ghani M, Khalili MR, Nowroozzadeh MH. The effect of sub-Tenon's bupivacaine on oculocardiac reflex during strabismus surgery and postoperative pain: A randomized clinical Trial. J Ophthalmic Vis Res 2017; 12(3): 296-300.
  3. Rodgers A, Cox RG. Anesthetic management for pediatric strabismus surgery: Continuing professional development. Can J Anaesth 2010; 57(6): 602-17.
  4. Mather SJ, Davy H. Anesthesia for strabismus surgery. Journal of Anaesthesia 2009; 43(11): 1095-9.
  5. Soltani HA, Jafari A. Influence of the anesthetic depth on the inhibition of the oculocardiac reflex during propofol anesthesia for pediatrics strabismus surgery. J Isfahan Med Sch 2011; 29(152): 1235-41. [In Persian].
  6. Fayon M, Gauthier M, Blanc VF, Ahronheim GA, Michaud J. Intraoperative cardiac arrest due to the oculocardiac reflex and subsequent death in a child with occult Epstein-Barr virus myocarditis. Anesthesiology 1995; 83(3): 622-4.
  7. Ibrahim AN, Shabana T. Sub-Tenon's injection versus paracetamol in pediatric strabismus surgery. Saudi J Anaesth 2017; 11(1): 72-6.
  8. Gupta N, Kumar R, Kumar S, Sehgal R, Sharma KR. A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery. Anaesthesia 2007; 62(11): 1110-3.
  9. Blanc VF. Atropine and succinylcholine: beliefs and controversies in paediatric anaesthesia. Can J Anaesth 1995; 42(1): 1-7.
  10. Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand 2008; 52(9): 1273-7.
  11. Oh AY, Yun MJ, Kim HJ, Kim HS. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth 2007; 99(2): 262-5.
  12. Sajedi P, Soleymani Nejad M, Montazeri K, Baloochestani E. Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anesthesia. Int J Prev Med 2013; 4(11): 1258-65.
  13. Lee GW, Chang BL. The effect of topical anesthesia on the oculocardiac reflex. J Korean Ophthalmol Soc 1986; 27(5):829-32. [In Korean].
  14. Oh JN, Lee SY, Lee JH, Choi SR, Chin YJ. Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean J Anesthesiol 2013; 64(6): 500-4.
  15. Barash PG. Clinical anesthesia. Philadelphia, PA: Lippincott Williams and Wilkins; 2009.
  16. Misurya VK, Singh SP, Kulshrestha VK. Prevention of oculocardiac reflex (O.C.R) during extraocular muscle surgery. Indian J Ophthalmol 1990; 38(2): 85-7.
  17. Braun U, Feise J, Muhlendyck H. Is there a cholinergic and an adrenergic phase of the oculocardiac reflex during strabismus surgery? Acta Anaesthesiol Scand 1993; 37(4): 390-5.
  18. Ruta U, Mollhoff T, Markodimitrakis H, Brodner G. Attenuation of the oculocardiac reflex after topically applied lignocaine during surgery for strabismus in children. Eur J Anaesthesiol 1996; 13(1): 11-5.
  19. Steib A, Karcenty A, Calache E, Franckhauser J, Dupeyron JP, Speeg-Schatz C. Effects of subtenon anesthesia combined with general anesthesia on perioperative analgesic requirements in pediatric strabismus surgery. Reg Anesth Pain Med 2005; 30(5): 478-83.
  20. Sinha R, Chandralekha, Batra M, Ray BR, Mohan VK, Saxena R. A randomised comparison of lidocaine 2% gel and proparacaine 0.5% eye drops in paediatric squint surgery. Anaesthesia 2013; 68(7): 747-52.
Journal of Isfahan Medical School
Volume 36, Issue 474 - Serial Number 474
March and April 2018
Pages 317-323

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History

  • Receive Date: 14 January 2018
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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