Factors Affecting Oculocardiac Reflex Incidence In Pediatric Strabismus Surgery: Retrospective Study

2021 ◽  
Author(s):  
Bengü Gülhan Aydın ◽  
Gamze Küçükosman ◽  
Özcan Pişkin ◽  
Bahar Aktaş ◽  
Rahşan Dilek Okyay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Sinus Bradycardia ◽  
Strabismus Surgery ◽  
Neuromuscular Blocker ◽  
Anesthesia Induction ◽  
Factors Affecting ◽  
Oculocardiac Reflex ◽  
Anesthetic Drugs ◽  
Duration Of Surgery

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Clinical Trial ◽  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Emergence Agitation ◽  
Oculocardiac Reflex

Abstract Background: Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods: In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results: Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion: Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery. Trial registration：The trial was prospectively registered before patient enrollment at Chinese Clinical Trial Registry (Clinical Trial Number: ChiCTR1800020176, Date: 12/19/2018). Keywords: Dexmedetomidine, Postoperative nausea and vomiting, Strabismus surgery, Oculocardiac reflex, Emergence agitation

scholarly journals Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wangseok Do ◽  
Hyo-Sung Kim ◽  
Seung Ha Kim ◽  
Hyunjong Kang ◽  
Dowon Lee ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Pediatric Patients ◽  
Group Analysis ◽  
Pediatric Anesthesia ◽  
Strabismus Surgery ◽  
Preschool Age ◽  
Anesthesia Induction ◽  
Emergence Delirium ◽  
Scale Scores ◽  
The Relationship

Abstract Background Emergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery. Methods This clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores. Results Of the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients. Conclusion In conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required. Trial registration This study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017.

Risk Factors for Surgical Site Infection in Children

2006 ◽  
Vol 27 (7) ◽  
pp. 709-715 ◽  
Author(s):  
Juan Francisco Casanova ◽  
Rafael Herruzo ◽  
Jesús Díez
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Pediatric Patients ◽  
Risk Index ◽  
Venous Catheter ◽  
University Hospital ◽  
Site Infection ◽  
Convenience Sample ◽  
Peripheral Venous Catheter ◽  
Duration Of Surgery

Objectives.To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.Design.Cohort study during more than 4 years.Setting.La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.Patients.Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.Results.A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.Conclusions.The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

scholarly journals Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094515
Author(s):  
Sun Young Shin ◽  
Min Ju Kim ◽  
Jin Joo
Keyword(s):  
Laryngeal Mask Airway ◽  
Medical Records ◽  
Pediatric Patients ◽  
Strabismus Surgery ◽  
Adult Patients ◽  
Laryngeal Mask ◽  
Spontaneous Respiration ◽  
Depth Of Anesthesia ◽  
Oculocardiac Reflex ◽  
Specific Muscle

Objective To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration. Methods The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed. Results The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively). Conclusions The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.

scholarly journals Surgical factors affecting oculocardiac reflex during strabismus surgery

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Suk-Gyu Ha ◽  
Jungah Huh ◽  
Bo-Ram Lee ◽  
Seung-Hyun Kim
Keyword(s):  
Strabismus Surgery ◽  
Factors Affecting ◽  
Oculocardiac Reflex

scholarly journals Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiacheng Sun ◽  
Xiaofei Cao ◽  
Ting Lu ◽  
Nan Li ◽  
Xinxu Min ◽  
...  
Keyword(s):  
Normal Saline ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Anesthesia Induction ◽  
Anticholinergic Agent ◽  
Double Blind Study ◽  
Double Blind ◽  
Oculocardiac Reflex

Abstract Background Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery. Methods In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded. Results Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P < 0.01) and mitigated PONV severity as indicated by severity scoring (P < 0.01). Compared with normal saline, penehyclidine also significantly reduced OCR incidence (57.9% vs. 77.9%, P < 0.01) and mitigated OCR severity, as indicated by the requirement for atropine rescue (77.3% vs. 90.1%, P < 0.05) and the maximum decrease of heart rate during OCR (23.1 ± 9.4 bpm vs. 27.3 ± 12.4 bpm, P < 0.05). The recovery course did not differ between groups. Conclusions Penehyclidine administrated after anesthesia induction significantly reduced the incidence of PONV and alleviated intraoperative OCR in patients undergoing strabismus surgery. Trial registration ClinicalTrials.gov (NCT04054479). Retrospectively registered August 13, 2019.

scholarly journals Oculocardiac and Oculorespiratory Reflex during Strabismus Surgery under General Anesthesia with Laryngeal Mask Airway for Maintaining Spontaneous Respiration: A Retrospective Study

2019 ◽  
Author(s):  
Sun Young Shin ◽  
Min Ju Kim ◽  
Jin Joo
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Pediatric Patients ◽  
Strabismus Surgery ◽  
Adult Patients ◽  
Laryngeal Mask ◽  
Spontaneous Respiration ◽  
Anesthesia Induction ◽  
Depth Of Anesthesia ◽  
Specific Muscle

Abstract Background: The oculocardiac reflex (OCR) is defined as a 10–20% reduction in heart rate (HR) from the baseline value or dysrhythmia, and the oculorespiratory reflex (ORR) manifests as shallow respiratory movement and bradypnea caused by manipulation of the eye. The aim of this study was to elucidate whether the specific muscle operated on has an effect on OCR and ORR, as well as whether the depth of anesthesia influences the OCR and ORR in patients undergoing strabismus surgery with laryngeal mask airway (LMA) to maintain spontaneous respiration. Methods: The medical records of patients who underwent strabismus surgery on lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were reviewed. For anesthesia induction, propofol was administered and the LMA was inserted. Anesthesia was maintained with sevoflurane and spontaneous respiration. Results: The incidences of OCR during LR and MR operations were not significantly different between pediatric and adult patients (29% vs 27% and 15% vs 16%, respectively, p < 0.05). The incidence of ORR, as indexed by tidal volume (TV), was higher during MR surgery than during LR surgery in pediatric patients (29.3% vs 10.1%, p < 0.05). The change in HR during muscle traction and bispectral index (BIS) showed a negative correlation in pediatric patients, but this was not statistically significant. The change in TV during muscle traction and BIS was significantly correlated, in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively, p < 0.05), while the change in respiratory rate (RR) during muscle traction and BIS did not show a significant correlation in either group. Conclusions: The incidence rate of OCR did not differ between LR and MR surgeries, and the depth of anesthesia did not correlate with HR changes during muscle traction. Young age and MR surgery may be risk factors for ORR. However, MV did not decrease because of the increased RR during muscle traction. Thus, maintenance of spontaneous respiration with an LMA is safe during strabismus surgery under general anesthesia for both pediatric and adult patients.

Sign in / Sign up

Export Citation Format

Share Document