ArticleClinical ophthalmology (Auckland, N.Z.)2021
Anesthetic Impacts on the Oculocardiac Reflex: Evidence from a Large, Observational Study.
Article in Clinical ophthalmology (Auckland, N.Z.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04353960 (The Alaska Oculocardiac Reflex Study), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Alaska Oculocardiac Reflex Study
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Life-threatening complications in ophthalmic surgery: a systematic review.Eye (London, England) · 2025Pooled it
- Oculocardiac Reflex During Strabismus Surgery: Conjunctival Incision versus Standardized Rectus Muscle Traction.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Comparison of Rocuronium and Cisatracurium in Ophthalmic Surgeries in Association with the Incidence of Intraoperative Bradycardia- A Retrospective Study.Drug design, development and therapy · 2025Article
- Article
- Prediction of the Occurrence of the Oculocardiac Reflex Based on the Assessment of Heart Rate Variability. An Observational Study.Ophthalmology and therapy · 2022Article
- Asystole Due to Oculocardiac Reflex during Surgical Repair of an Orbital Blowout Fracture.Plastic and reconstructive surgery. Global open · 2022Article
- Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial.Journal of ophthalmology · 2022Article
- The Oculocardiac Reflex: A Review.Clinical ophthalmology (Auckland, N.Z.) · 2021Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe oculocardiac reflex (OCR) is a sudden vagal bradycardia that can be elicited by traction on an extraocular muscle. Bradycardia is highly variable from case to case necessitating a large sample size to observe small to moderate impact on OCR. While the surgeon's tissue manipulation has immediate impact on OCR and individual patients may have some proclivity to OCR, we sought to characterize the impact on OCR by the anesthesiologist.
methodsFrom 1992 to 2019, during routine, community outpatient general anesthetic strabismus surgery, oculocardiac reflex was prospectively observed utilizing a uniform 10-second, 200 gram square wave tension on each extraocular muscle. Anesthetic parameters were recorded and analyzed with double-cohort design and non-parametric statistics and correlations. We define %OCR as the maximally tension-altered heart rate and a percent of stable pre-tension heart rate.
resultsThe median (IQR) confidence intervals OCR for 2527 initial cases was 89% (67% to 97%) without anticholinergic, and 99% (95% to 100%) in 165 patients with anticholinergic. OCR was 81% (62% to 96%) in 1034 with opioids and to 75% (60% to 95%) in 59 with dexmedetomidine and in 189 with IV dexamethasone to 72% (56% to 92%) There was a significant (p<0.01 Kruskal-Wallis) impact on OCR by various opioids, muscle relaxants and inhalational agents. Linear regression showed significant inhibitory impact on OCR by increased inhalational agent depth and by lower exhaled CO
conclusionThe anesthesiologist can block OCR with sufficient anticholinergics, deeper inhalational agents and robust ventilation, and can augment OCR with opioids, dexmedetomidine and apparently also with dexamethasone. CLINICAL TRIALS REGISTRY: NCT04353960.
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