oculocardiac reflex(OCR)

Teshome A.
Date (04/12/2013 EC)
 Anatomic R/sh of CN5 &10
• also known as the trigeminovagal reflex.
• afferent of the reflex limb arises from
 the ophthalmic division of the CN5 continues to the
Gasserian ganglion .
 Finally sensory nucleus of the CN5 goes to near the 4th ventricle.
 At 4th ventricle the afferent limb synapses with the motor
nucleus of the CN10 that finally go to the heart.
 Cause of OCR
• Caused by trigeminal nerve
 mainly the ophthalmic division of cranial nerve (CN V))
forming the afferent limb.
• trigeminal nerve synapses with the visceral motor
nucleus of the vagus nerve (CN X) in the reticular
formation of the brain stem to form the efferent limb of
the reflex arc.
• Hypercarbia & hypoxemia augment OCR.
Cause of OCR….
 Cause of OCR….
• OCR is elicited by ;
 external pressure on the globe,
 traction of the extraocular muscles (medial rectus),
 conjunctiva,
 Traction on orbital structures,
 performing an ophthalmic regional block (i.e., retrobulbar
block).
 ocular trauma
 Cause of OCR….

• cataract extraction,
• enucleation,
• retinal detachment repair.
• Incidence: 50-82%
 C/M of OCR
• Commonest: sinus bradycardia
• Dysrhythmias
 atrioventricular blockage,
 multifocal premature ventricular contractions
 junctional rhythms,
 ventricular bigeminy, or
 asystole.
 Who is predisposed to OCR?
• Common in pediatric population undergoing strabismus
surgery.
 May be due to increased vagal tone in children.

 administer IV atropine (0.02 mg/kg) or glycopyrrolate

(0.01 mg/kg) prior to such surgery in children
 Who is predisposed to OCR? ....

• Prophylaxis IV atropine is not good in adult b/c of;

 risk of inducing cardiac dysrhythmias and conduction
abnormalities like;
 left bundle branch block,
 ventricular tachycardia, or
 ventricular fibrillation
 T/T of OCR
1. Ask surgeon to stop the surgical stimulus.
2. Deepen anesthesia with inhalational agent or retrobulbar
block.
3. Revaluate oxygenation, & ventilation
4. IV atropine
5. With repeated manipulation of the extraocular muscles,
reflex is less likely to occur,
 May be due to fatigue of the reflex arc.
 References
1. Paul K. Sikka, Basic Clinical Anesthesia
2. G. Edward Morgan, Clinical Anesthesiology,
6th ed.
3. Miller's Anesthesia 9th ed.
4. Barash, Paul G. Clinical anesthesia 8th ed.
Thank you!