Anaes · Ophthalmic anaesthesia
Oculocardiac reflex and intraocular pressure under anaesthesia
Also known as Oculocardiac reflex and intraocular pressure under anaesthesia
Exam-exhaustive OCR pathway and treatment (stop stimulus, atropine 10–20 microg/kg) plus IOP pharmacology (normal 10–21 mmHg; sux +5–10 mmHg) for ANZCA Final, FRCA, and equivalents including open-globe and strabismus crisis pivots.
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Red flags
- OCR: afferent V1 trigeminal; efferent vagus.
- Treatment: stop stimulus first, then atropine/glycopyrrolate.
- Atropine 10–20 microg/kg IV if persistent.
- Sux raises IOP ~5–10 mmHg briefly.
- Normal IOP about 10–21 mmHg.
Meet the patient
A four-year-old is on the table for medial rectus recession. The surgeon takes traction on the muscle, and the heart rate drops from 110 to 38 in two beats. Your registrar calls for atropine. The surgeon is still pulling.[1]
The two questions every ophthalmic list hangs on: have they stopped pulling, and is the ECG on? The arc is fixed, the dose is fixed, and the sequence is fixed — stop stimulus first, drug second. Giving atropine while traction continues is the classic viva fail.[1]
References4ShowHide
- [1]Arnold RW The Oculocardiac Reflex: A Review. Clin Ophthalmol, 2021.PMID 34194223
- [2]Vachon CA, Warner DO, Bacon DR Succinylcholine and the open globe. Tracing the teaching. Anesthesiology, 2003.PMID 12826863
- [3]Pucchio A, Pur DR, Dhawan A, et al. Anesthesia for ophthalmic surgery: an educational review. Int Ophthalmol, 2023.PMID 36436168
- [4]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528