Anesthesia Management of Oculocardiac Reflex in Strabismus Surgery: A Case Study

Abstract

There are various types of eye surgery with each requires special attention in anesthesia management. Strabismus surgery has several risks that need to be considered; one of which is oculocardiac reflex. The oculocardiac reflex is a condition characterized by decreased heart rate caused by the pressure on the globe or by traction on the extraocular muscles and conjunctiva or the orbital structures. This reflex can manifest as an asystole if left untreated. This is a case report of a 19-year-old male with ASA classification 1 presented with esotropia of left and right eyes. General anesthesia was used for anesthesia with 100 mcg fentanyl, 100 mg propofol, and 25 mg atracurium for induction and, for airway management, LMA size 3 was used. Sevoflurane 2–3 vol% with oxygen and nitrous oxide was given as maintenance. During the surgery, the heart rate dropped to 35 beats per minute when the operator pulled the medial rectus muscle in the first eye. The surgery was then paused and the heart rate was incrementally increased to 65 beats per minute without any other intervention. Then, as the operator pulled the medial rectus muscle in the second eye, the heart rate decreased to 55 beats per minute and the surgery continued with the heart rate slowly increased without any intervention. The remaining surgery time was uneventful. Knowledge and early intervention of oculocardiac reflex conditions should be well understood by all anesthesiologist to avoid more catastrophic conditions.