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      Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study

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          Abstract

          Objective

          To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration.

          Methods

          The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed.

          Results

          The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r 2 = 0.034 and 0.058, respectively).

          Conclusions

          The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.

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          Most cited references25

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          Response of bispectral index to neuromuscular block in awake volunteers.

          The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that is widely used to assess the hypnotic component of anaesthesia, especially when neuromuscular blocking drugs are used. It has been shown that the BIS is sensitive to changes in electromyogram (EMG) activity in anaesthetized patients. A single study using an earlier version of the BIS showed that decreased EMG activity caused the BIS to decrease even in awake subjects, to levels that suggested deep sedation and anaesthesia.
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            Sympathetic neural outflow and chemoreflex sensitivity are related to spontaneous breathing rate in normal men.

            Respiration contributes importantly to short-term modulation of sympathetic nerve activity. However, the relationship between spontaneous breathing rate, chemoreflex function, and direct measures of sympathetic traffic in healthy humans has not been studied previously. We tested the hypothesis that muscle sympathetic nerve activity and chemoreflex sensitivity are linked independently to respiratory rate in normal subjects. We studied 69 normal male subjects aged 29.6+/-8.1 years. Subjects were subdivided according to the tertiles of respiratory rate distributions. Mean respiration rate was 10.6 breaths/min in the first tertile, 14.8 breaths/min in the second tertile, and 18.0 breaths/min in the third tertile. Subjects from the third tertile (faster respiratory rate) had greater sympathetic activity than subjects from the first tertile (slower respiratory rate; 29+/-3 versus 17+/-2 bursts/min; P<0.001). Stepwise multiple linear regression analysis revealed that only respiratory rate was linked independently to sympathetic activity (r=0.42; P<0.001). In comparison to subjects with slow respiratory rate, subjects with fast respiratory rate had greater increases in minute ventilation during both hypercapnia (7.3+/-0.8 versus 3.2+/-1.0 L/min; P=0.005) and hypoxia (5.7+/-0.8 versus 2.4+/-0.7 L/min; P=0.007). Muscle sympathetic nerve activity and chemoreflex sensitivity are linked to spontaneous respiratory rate in normal humans. Faster respiratory rate is associated with higher levels of sympathetic traffic and potentiated responses to hypoxia and hypercapnia. Spontaneous breathing frequency, central sympathetic outflow, and chemoreflex sensitivity exhibit significant and hitherto unrecognized interactions in the modulation of neural circulatory control.
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              The oculocardiac reflex: a graphic and statistical analysis in infants and children.

              A new method for the detection and recording of the oculocardiac reflex (OCR) is described and applied to 49 healthy infants and children (six months to nine years old) undergoing strabismus surgery under halothane anaesthesia with spontaneous ventilation. Eighty-one extraocular muscles were studied. Square wave stimuli (abrupt and sustained tractions) were definitely more reflexogenic than slow slope stimuli (very gradual, progressive and gentle tractions). Vagal escape, as well as fatigue of the OCR, are graphically documented and analysed. In this series, using well-defined and controlled tractions, the medial rectus was not more reflexogenic than the other extraocular muscles. Hypercapnia was an important adjuvant factor of the OCR. Controlled ventilation is recommended. The routine use of intravenous anticholinergic drugs is briefly discussed. Prevention of the OCR, and prophylaxis of cardiac arrhythmias during strabismus surgery, now seem to be placed on a more rational basis.
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                Author and article information

                Journal
                J Int Med Res
                J. Int. Med. Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                12 August 2020
                August 2020
                : 48
                : 8
                : 0300060520945158
                Affiliations
                [1 ]Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                [2 ]Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                [*]Jin Joo, Department of Anesthesia and Pain Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Email: jiyo1004@ 123456catholic.ac.kr
                Author information
                https://orcid.org/0000-0002-4260-9397
                Article
                10.1177_0300060520945158
                10.1177/0300060520945158
                7427032
                32787487
                8854a0f5-a661-4207-85c0-7ef2b7075ed0
                © The Author(s) 2020

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 19 November 2019
                : 6 July 2020
                Categories
                Retrospective Clinical Research Report
                Custom metadata
                ts2

                strabismus surgery,laryngeal mask airway,oculocardiac reflex,oculorespiratory reflex,depth of anesthesia,spontaneous respiration

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