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January 1965

The Oculocardiac Reflex During Extraocular Muscle Surgery

Author Affiliations

Chief of Anesthesiology (Capt Welhaf) and Chief of Ophthalmology (Capt Johnson), USAF Hospital Chanute, Chanute Air Force Base, Illinois.

Arch Ophthalmol. 1965;73(1):43-45. doi:10.1001/archopht.1965.00970030045010

Introduction  For years, physicians have known about the oculocardiac reflex. Paroxysmal auricular tachycardia could frequently be reverted to a slower, normal rhythm by ocular massage, and many physicians have used this as initial therapy. Ophthalmologists and anesthesiologists have also been interested in the reflex, because several cardiac arrests during ocular surgery have been attributed to it. During the past decade, several clinical studies have shed more light on the subject. Kirsch,1-3 collaborating with other authors on several reports, found that the reflex is apt to occur with extraocular muscle traction, ocular pressure, intraorbital injections, and compression of apical contents after enucleation. Several factors predisposing the reflex were noted to be fear, hypoxia, hypercapnia, sensitivity to, and overdose of drugs. Although the bradycardia happens in a large percentage of cases, Kirsch believed that cardiac arrest occurred about once in approximately 3,500 eye operations. Although Kirsch1 and Taylor4 believe

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