oculocardiac reflex

Keyword

Oculocardiac reflex

Definition

Traction on the extraocular muscles or pressure on the globe causes bradycardia, atrioventricular block, ventricular ectopy, or asystole.

Pathophysiology

The reflex is trigeminovagal.

• The afferent limb is from orbital contents to ciliary ganglion to ophthalmic division of the trigeminal nerve to the sensory nucleus of the trigeminal near the fourth ventricle.
• The efferent limb is via the vagus nerve to the heart.

Treatment

• 먼저 수술자에게 알려 조작을 멈추게 한다
• significant bradycardia가 지속되거나 재발하면 IV atropine ( 7-μg/kg )

Prevention

Intravenous atropine or glycopyrrolate can be effective

Pretreatment may be indicated in patients with a history of

• conduction block
• vasovagal responses
• β-blocker therapy.

Reference

Miller’s Anesthesia, 8th edition, Ch.84, P.2513