Bradycardia, Strabismus
Conditions
Keywords
oculocardiac reflex
Brief summary
Observation study monitoring vital signs and anesthetic variables particularly heart rate during prospective, ocular manipulation and specifically uniform tension on extra ocular muscles during strabismus surgery. \*IRB approval from 1992 covered in letter from then IRB chair Dr. Judith Whitcomb, Anchorage, Alaska (letter 10/2020).\*
Detailed description
Patients with ocular manipulation including those scheduled for strabismus surgery will have peri-operative variables monitored before, during and after uniform traction on extra ocular muscles (EOM). The oculocardiac reflex (OCR) will be elicited by quantified (200 gram, 10-second, square-wave) traction on Jameson muscle hook under insertion of an extra ocular muscle (EOM, rectus). Stable pre-tension heart rate, and greatest change heart rate will be recorded. Additional variables to be recorded: birthdate, gender, race, weight, iris color, pre-operative neurodevelopmental conditions, pre-operative medications, induction medications, expired carbon dioxide (CO2) levels, exhaled gas concentrations, anticholinergic medications, opioids, muscle relaxants, type of airway and the number of EOM operated.
Interventions
DIAGNOSTIC_TESTelectrocardiograph
electrocardiograph monitor during strabismus surgery
Sponsors
Alaska Blind Child Discovery
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Months to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Patient scheduled for ocular manipulation and tension on extra ocular muscles and strabismus surgery
Exclusion criteria
* anophthalmia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent heart rate resulting from oculocardiac reflex | 30 seconds | Continuous variable of percent change in heart rate from stable pre-heart rate to greatest change heart rate during strabismus surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anesthetic interventions | 2 hours | Impact of existing and emerging anesthetics on oculocardiac reflex. This shall include various existing and emerging medications and inhalation agents, dosage, routes, airway types, general anesthesia and awake, and monitor methods. |
| Patient Characteristics | 2 hours | The impact of various patient characteristics on oculocardiac reflex including patient age, weight, gender and race, the presence of neuro-developmental condition. |
| Surgeon Interventions | 2 hours | The impact of various aspects/phases of ocular manipulation and/or surgical technique. This includes monitored electrocardiograph during insertion of lid speculum, pressure on the globe, grasping of conjunctiva, incision of conjunctiva, dissection of Tenon's capsule, traction on extra ocular muscle, suturing extra ocular muscle, disinsertion of extra ocular muscle, re-suturing of extra ocular muscle and closure of conjunctiva. |
Countries
United States
Contacts
Primary ContactRobert W Arnold, MD
Backup ContactBrion J Beerle, MD
Outcome results
None listed