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CARDIAC SLOWING DURING STRABISMUS SURGERY

1962; BMJ; Volume: 46; Issue: 2 Linguagem: Inglês

10.1136/bjo.46.2.112

1468-2079

Hasina Outtz Reed, Tristan McCaughey,

Ophthalmology and Eye Disorders

CARDIAC arrest is a frightening complication which may confront a surgeon at any operation.It is fortunate that it is relatively uncommon, but there is a danger of false security.Eye surgeons face this complication less fre- quently than general or thoracic surgeons, but few of those who have practised for many years have not met cases of actual or threatened cardiac arrest.Kirsch, Samet, Kugel, and Axelrod (1957) have estimated that cardiac arrest occurs in about 1 in 1,500 cases in general surgery and in about one in 3,500 cases in eye operations.Snyder, Snyder, and Chaffin (1953) considered that cardiac arrest occurs in about 1 in 2,500 cases.Milstein (1956) quoted estimates varying from 1 in 858 to 1 in 4,950 operations.Gartner and Billet (1958) estimated that about 45 deaths occurred during eye surgery in the United States of America every year.This problem is, therefore, a very real one. Review of the LiteratureThe oculo-cardiac reflex was described simultaneously by Aschner (1908) and Dagnini (1908).Aschner's report is particularly comprehensive.He investigated this reflex in animals and was the first to record that pressure upon the eyeballs caused bradycardia.He experimented by cutting the oculomotor, trochlear, abducens, facial, and auditory nerves, and found that an intact trigeminal nerve was essential for the production of the reflex.He also found that stimulation of any of the branches of the trigeminal nerve produced the reflex, and that pressure upon the tissues remaining at the apex of the orbit after enucleation would cause slowing of the heart.He made the interesting comment that pressure upon both eyes of a rabbit might slow or even arrest the heart beat temporarily but it was not possible to kill the rabbit in this way.He observed that, whereas in dogs and human beings the reflex acted mainly upon the heart, in rabbits the respiration was more seriously affected.In the case of one rabbit respirations were slowed for 3 minutes, but they gradually returned to normal despite continued pressure upon the eyes.Aschner further discovered that the reflex was more readily evoked under anaesthesia than in the waking state.Since these early observations, many reports have appeared showing that serious bradycardia, vomiting, and shock may *