This has been studied in animals and known for more than a century,46 and is now considered as the trigeminocardiac reflex tcr. Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery syed mushtaq gilani, muhammad jamil, farhat akbar, roomana jehangir department of anaesthesiology, ayub medical college and teaching hospital, abbottabad background. The reflex is greatly exaggerated in the presence of hypoventilation, hypoxemia and acidosis. Oculocardiac reflex elicited during debridement of an empty orbit oculocardiac reflex elicited during debridement of an empty orbit tsai, james c heitz, james w. Coronary spasm in neurosurgical patients and role of trigeminocardiac reflex. The afferent limb has nerve fibers running within the optic nerve. Trigeminocardiac reflexes maxillary and mandibular. Such an indication is related to orbital floor fracture when it induces the oculocardiac reflex ocr, a condition which clinically manifests as headache, nausea, vomiting, bradycardia and potential syncope. The pathophysiological mechanism of this reflex is shown in fig. In a simple reflex this includes a sensory receptor, afferent or sensory neuron, reflex center in the brain or spinal cord, one or more efferent neurons, and an effector organ. The oculocardiac reflex is a parasympathetic or rest and digest reflex. Pdf oculocardiac reflex and maxillofacial surgical. Sep 05, 2017 oculocardiac reflex incidence 30% to 90% the oculocardiac reflex is most commonly encountered in pediatric patients undergoing strabismus surgery, although it can be evoked in all age groups and during a variety of ocular procedures, this reflex consists of a trigeminal v1 afferent and a vagal x efferent pathway.
The oculocardiac reflex ocr is a widely investigated and wellestablished phenomenon, induced by the stimulation of the ocular and periocular structures innervated by the ophthalmic division of the trigeminal nerve. Functions or reflex action maintain the homeostasis b. Oct 25, 2012 autonomic nervous system activity and oculocardiac reflex. Autonomic nervous system activity and oculocardiac reflex. In 1908, aschner described a decrease in heart rate as a consequence of applying pressure directly to the eyeball. It involves the patellar kneecap tendon and a group of upper leg muscles. The oculocardiac reflex slows the heart action, giving extraordinary rest to this. Of the two anticholinergic medications used, there appears to be less bradycardia with atropine as opposed to gallamine, 0% vs.
The vagus nerve, also known as cranial nerve ten, comprises the efferent limb of the ocr. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Profound bradycardia during eye surgery is potentially serious event. In the early 20th century, this tcr has gained much clinical attention, in the form of the oculocardiac reflex. The ocr arc consists of an afferent and efferent limb. Jan 26, 2016 functions or reflex action maintain the homeostasis b. Oculocardiac reflex in a medial orbital wall fracture without. Oculocardiac definition of oculocardiac by medical. Oculocardiac reflex in a pediatric orbital floor fracture. Oculocardiac reflex and maxillofacial surgical procedures article pdf available in international journal of oral and maxillofacial surgery 3611. Stop constipation with this littleknown neurology trick dr. Listing a study does not mean it has been evaluated by the u. Oculocardiac reflex caused by orbital floor trapdoor fracture.
Oculocardiac reflex article about oculocardiac reflex by. The ophthalmic division of the trigeminal nerve is the afferent limb of the ocr. The reported incidence of the oculocardiac reflex varies from 14% to 90%, depending on the study, making it relatively common. Recently, with the understanding that stimulation of the trigeminal nerve in areas other than the ophthalmic branch v 1 can occur, a more comprehensive term, trigeminocardiac reflex, has come into use. Trapdoor fractures most often involve the orbital floor 3 and not surprisingly an oculocardiac reflex has most often been described in association with inferior trapdoor fractures. A familiar reflex is the kneejerk or stretch reflex. The major pathway mediating the ocr seems to consist of an afferent pathway through the ophthalmic division of fifth cranial nerve called trigeminal to the nucleus of vagus nerve and an ef. The oculocardiac reflex was the first wellrecognized tcr phenomenon. Figure lthe reflex pathway of the oculocardiac reflex. The oculorespiratory cardiac reflex in the dog iovs. Stop constipation with this littleknown neurology trick.
Oculocardiac reflex caused by orbital floor trapdoor. Reflex bradycardia in facial surgery journal of plastic. This is particularly relevant to paramedics who are treating a patient with an injury who becomes bradycardic. Iatrogenic oculocardiac reflex in a patient with head. Physiology being an involuntary action or response, such as a sneeze, blink, or hiccup. Home pediatric anesthesia podcast of the month oculocardiac reflex. The oculocardiac reflex ocr is a potentially serious complication of ophthalmic surgery which is most commonly elicited during paediatric strabismus surgery. Pdf physiology of oculocardiac reflex varun malhotra. The oculocardiac reflex, also known as aschner phenomenon, aschner reflex. Atropine, cardiac reflex, oculocardiac reflex, skull base surgery, treatment, trigemino introduction the trigeminal nerve is the largest of the cranial nerves. The autonomic imbalance between the sympathetic and parasympathetic systems is associated with a variety of stimulations that arise during head and neck surgery. Atropine, cardiac reflex, oculocardiac reflex, skull base surgery, treatment, trigemino.
Pdf anticholinergic premedication for prevention of. The sensory side of the reflex arc conveys specificity as to which reflex will be activated. Pdf profound bradycardia during eye surgery is potentially serious event. The oculocardiac reflex is a neonatal reflex where pressure on the eyes is sensed by cranial nerve 5 trigeminal nerve to then trigger cranial nerve 10 vagus nerve to start slowing down the heart. The baroreflex or baroreceptor reflex is one of the bodys homeostatic mechanisms that helps to maintain blood pressure at nearly constant levels.
Oculocardiac reflex ocr or aschnerdagnini reflex was first discovered in 1908 1. A current explanation of the mechanism suggests that the afferent pathway of the reflex arc is made up of sensory nerve endings of the trigeminal nerve sending neuronal signals via the gasserian ganglion back to the sensory. It occurs through ophthalmic branch of trigemino nerve. The afferent and efferent pathways of the oculocardiac reflex are described in detail, and the rationale of the phenomenon discussed. The afferent pathway continues along the short internuncial.
Sharma and others published oculocardiac reflex and maxillofacial. The major pathway mediating the ocr6 consists of an afferent link through the ophthalmic portion of the trigeminal nerve to the vagus nuclei and an. Alternative afferent pathways must exist via the maxillary andor mandibular divisions, in addition to the commonly reported pathway via the ophthalmic division of the trigeminal nerve in the classic oculocardiac reflex. Oculocardiac reflex in a medial orbital wall fracture. The oculocardiac reflex slows the heart action, giving extraordinary rest to this vital organ. Muscle spindles consist of three to 12 small muscle fibres encased in a connective tissue capsule which is connected to the glycocalyx of the surrounding extrafusal skeletal muscle fibres which make up the vast bulk of. Electrocardiographic changes during ocular surgery and their prevention by retrobulbar injection. The parasympathetic supply to the face is carried in the trigeminal nerve. Get a printable copy pdf file of the complete article 535k, or click on a page image below to browse page by page. An oculocardiac reflex ocr can be triggered by the eye examination for retinopathy of prematurity rop. The oculocardiac reflex ocr is a reflex resulting in severe bradycardia caused by traction applied to the extraocular. Facts and own experience belachew arasho1,4, nora sandu2.
Attenuation of the oculocardiac reflex after topically appli. As the oculocardiac reflex is a vagal response, clinicians have attempted to abolish the vagal stimulation of the heart using atropine and gallamine. Oculocardiac reflex an overview sciencedirect topics. The oculocardiac reflex is a triad of bradycardia, nausea, and syncope. Also afferent tracts from maxillary and mandibular divisions of trigeminal nerve have been documented. They depend on an intact neural pathway between the stimulation point and a responding organ. Oculocardiac reflex as a predictive sign of postoperative nausea and vomiting following strabismus surgey in children e. The physiological response known as oculocardiac reflex identifies a unique decrease in pulse rate associated with any traction of the extraocular muscles or compression of the eyeball itself. The oculocardiac reflex ocr was first described by aschner and dagnini in 1908. We did a pub med search for the terms coronary artery spasm, neurosurgery, intraoperative oculocardiac reflex and trigeminalcardiac reflex from 1 january 1970 to 31 march 20 for all the relevant publications in any language. The association between the oculocardiac reflex and post.
Maxillofacial surgeons seldom encounter facial fractures that warrant urgent treatment. The impulses pass through the reticular formation to the vagus nerves visceral motor nuclei. Comparing the preventive effect of 2 percent topical. This phenomenon would eventually be termed the oculocardiac reflex and is defined clinically as a decrease in heart rate by 10% following pressure to the globe or traction of the ocular muscles. Warren3 1anaesthetic department, burton hospitals nhs foundation trust, belvedere road, burton on trent, staffordshire, de 0rb, uk. Iatrogenic oculocardiac reflex in a patient with head injury. The oculocardiac reflex also known as trigeminovagal reflex, aschner phenomenon, aschner reflex, or aschnerdagnini reflex, is a reduction in heart rate bradycardia associated with traction applied to extraocular muscles andor compression of the eyeball 1 the oculocardiac reflex is defined by a decrease in heart rate by greater than 20% following globe pressure or. Right consensual pupillary reflex is the right pupils indirect response to light entering the left eye, the contralateral eye. Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery. The trigeminocardiac reflex tcr, previously known as the oculocardiac reflex ocr or aschner phenomenon, is a relatively wellknown reflex that may arise through manipulation of the trigeminal nerve, via its pathway from the cranial base to its nerve endings on the mouth, jaws, and face. The pupillary light reflex neural pathway on each side has an afferent limb and two efferent limbs.
Pdf death from the oculocardiac reflex michael wal. The oculocardiac reflex is a dysrhythmic physiological response to physical stimulation of the eye or adnexa. The effect of anaesthesia depth on oculocardiac reflex the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Sudden death in strabismus surgery under local anaesthesia. The ocr occurs during traction on the extraocular muscles, particularly pressure on the bulbus, intraorbital injections. Oculocardiac reflex synonyms, oculocardiac reflex pronunciation, oculocardiac reflex translation, english dictionary definition of oculocardiac reflex. The oculocardiac reflex ocr is also known as the aschnerdagnini reflex, having been reported separately in 1908, first by guiseppe dagnini and later, bernard aschner 1,2. Links to pubmed are also available for selected references. The efferent arc involves the vagus, regardless of which branch of the trigeminal nerve transmits the afferent impulses. Bradycardia can follow eye drops, insertion of the.
Review article management of the trigeminocardiac reflex. Pdf oculocardiac reflex and maxillofacial surgical procedures. Oculocardiac reflex definition of oculocardiac reflex by. The oculocardiac reflex ocr was first described, in 1908, by aschner and dagnini, who discovered this phenomenon simultaneously but independently. May be obtunded by local anaesthetic infiltration of ocular muscles d. Oculocardiac reflex to understand the probable mechanism of the ocr, we should consider the neurology of the eye. Oculocardiac definition of oculocardiac by medical dictionary. The effect of anaesthesia depth on oculocardiac reflex.
The impulses pass through the reticular formation to. Oculocardiac reflex incidence 30% to 90% the oculocardiac reflex is most commonly encountered in pediatric patients undergoing strabismus surgery, although it can be evoked in all age groups and during a variety of ocular procedures, this reflex consists of a trigeminal v1 afferent and a vagal x efferent pathway. Atropine, cardiac reflex, oculocardiac reflex, skull base surgery, treatment, trigemino introduction the trigeminal nerve is. Mar 05, 2015 the effect of anaesthesia depth on oculocardiac reflex the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The oculocardiac reflex ocr is a trigeminovagal reflex most commonly observed as bradycardia during extra ocular muscle tension in strabismus surgery. Muscle spindles consist of three to 12 small muscle fibres encased in a connective tissue capsule which is connected to the glycocalyx of the surrounding extrafusal skeletal muscle fibres which make up the vast bulk of the muscle. Anticholinergic premedication for prevention of oculocardiac.
Oculocardiac reflex as a predictive sign of postoperative. The efferent portion is carried by the vagus nerve from the cardiovascular center of the medulla to the heart, of which increased stimulation leads to decreased. The oculocardiac reflex, also known as aschner phenomenon, aschner reflex, or aschnerdagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles andor compression of the eyeball. The remainder of the reflex response is governed by the specific synaptic connections that lead to the effector neurons. The trigeminal nerve, otherwise known as the fifth cranial nerve.
The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the heart rate to decrease and also causes blood pressure to decrease. Oculocardiac reflex elicited during debridement of an. Attenuation of the oculocardiac reflex after topically. All patients undergoing maxillofacial procedures should be monitored carefully. Bradycardia can follow eye drops, insertion of the lid oculocardiac reflex with rop exams on vimeo. Oculocardiac reflex is one of the trigeminovagal reflexes, and is frequently observed during anesthesia for pediatric strabismus surgery.