Articles

Ketamine or Atropine: Which One Better Prevents Oculocardiac Reflex During Eye Surgery? a Prospective Randomized Clinical Trial

Abstract

Profound bradycardia during eye surgery is a potentially serious event. In clinical practice oculo-cardiac reflex (OCR) is most often encountered during squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of ketamine as an induction drug and anticholinergic premedication (atropine) to prevent OCR. This study comprised 90 patients (aged 4-10 years) operated for squint surgery under general anesthesia. Patients were divided into three groups. Using block randomization, each patient enrolled in one of the three groups based on organized random table prepared by statistician. Group K received ketamine as an induction drug, Group A was premedicated with intravenous injection of atropine and Group C did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. The observed data showed occurrence of 63% OCR in Group C as compared to 43% in group A and only 20% in Group K. Current study showed that induction with ketamine in the patients of squint surgery under general anesthesia definitely obtunds OCR and prevents any untoward effects of dysrhythmias during eye surgery.

Deb K, Subramaniam R, Dehran M, et al. Safety and efficacy of peribulbar block as adjunct to general anesthesia for pediatric ophthalmic surgery. Pediatric Anaesth 2001;11(2):161-7.

Miller RD, Eriksson LI, Fleisher LA, et al, editors. Miller's Anesthesia. 7th ed. London: Churchill Livingstone; 2010: p. 4753.

Ghai B, Makkar JK, Arora S. Intraoperative cardiac arrest because of oculocardiac reflex and subsequent pulmonary edema in a patient with extraocular cysticercosis. Pediatr Anesth 2006;16(11):1194-5.

Yamashita M. Oculocardiac reflex and the anesthesiologist. Middle East J Anesthesiol 1986;8(5):399-415.

Choi SR, Park SW, Lee JH, et al. Effect of different anesthetic regimes on the oculocardiac reflex during pediatric strabismus surgery. J Anesth 2000;23(4):489-93.

Gold RS, Pollard Z, Buchwald IP. Prevention of oculocardiac reflex during strabismus surgery. A report of two cases. Ann Ophthalmol 1988;20:473-5.

Mirakhur RK, Jones CJ, Phar B, et al. IM or IV atropine or glycopyrrolate for the prevention of O.C.R in children undergoing squint surgery. BJA 1982;54(10)1059-63.

Khurana I, Sharma R, Khurana AK. Experimental study of oculocardiac reflex (OCR) with graded stimuli. Indian J Physiol Pharmacol 2006;50(2):152-6.

Arnold R. Oculocardiac reflex caused by contact lenses. (Author reply). Ophthalmic Physiol Opt 2003;23(6):571-2.

Hunsley JE, Bush GH, Jones CJ. A study of glycopyrrolate and atropine in suppression of oculocardiac reflex duringmstrabismus surgery in children Br J Anesth 1982;54(4):459-64.

Yamamura T, Kimura T, Furukawa K. Effects of halothane, thiamylal, and ketamine on central sympathetic and vagal tone. Anesth Analg 1983;62(2):129-34.

Krystal JH, Karper LP, Seibyl JP, et al. subanesthetic effect of noncompetitive NMDA antagonist, ketamine, in human. Psycho mimetic, perceptual, cognitive, and neuroendocrine responses. Arc Gen psychiatry 1994;51(3):199-214.

Badrinath S, Avramov MN, Shadrick M, et al. the use of ketamine propofol combination during monitored anesthesia care. Anesth Analg 2000;90(4):858-62.

Choi SH, Lee SJ, Kim SH, et al. single bolus ofintravenous ketamine for anesthetic induction decreases oculocardiac reflex in children undergoing strabismus surgery. Acta Anesthesiol Scand 2007;51(6):759-62.

Files
IssueVol 53, No 3 (2015) QRcode
SectionArticles
Keywords
Reflex oculocardiac Atropine Ketamine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or Atropine: Which One Better Prevents Oculocardiac Reflex During Eye Surgery? a Prospective Randomized Clinical Trial. Acta Med Iran. 1;53(3):158-161.