Oculocardiac Reflex during Ptosis Operation under Local Anesthesia

Hyun-Gu Kang; Keun-Hae Kim

doi:10.3341/jkos.2008.49.1.1

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Kang and Kim: Oculocardiac Reflex during Ptosis Operation under Local Anesthesia

Original Article

J Korean Ophthalmol Soc 2008;49(1):1-7.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.1

Oculocardiac Reflex during Ptosis Operation under Local Anesthesia

Hyun-Gu Kang, M.D., Keun-Hae Kim, M.D.

Department of Ophthalmology, College of Medicine, Catholic University of Daegu, Daegu, Korea

Address reprint requests to Keun-Hae Kim, M.D. Department of Ophthalmology, College of Medicine, Catholic University of Daegu #3056-6 Daemyung-4-dong, Nam-gu, Daegu 705-718, Korea Tel: 82-53-650-4148, Fax: 82-53-627-0133, E-mail: kimkh@cu.ac.kr

Received 16 May 2007 Accepted 4 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence and examine the development of oculocardiac reflex during ptosis operation under local anesthesia.

Methods

Twenty-eight patients (52 eyes) who underwent ptosis operation under local anesthesia participated in this prospective study. We examined the change of heart rate. We also investigated the incidence of oculocardiac reflex and analyzed factors associated with it.

Results

The mean preoperative heart rate was 76.06±11.24 beats/min. During local anesthetic injection, skin incision, traction of the central fat pad, traction of the medial fat pad, traction of the levator palpebrae muscle, the mean heart rates were 74.81±12.64 beats/min, 74.73±12.20 beats/min, 73.63±11.73 beats/min, 73.35±12.24 beats/min, 71.44±11.93 beats/min respectively. Hence, the mean heart rate decreased during each successive part of the operation. The oculocardiac reflex was positive in 24 (46.2%) of 52 eyes. There was no significant difference between the incidence of oculocardiac reflex in males and females. The incidence of oculocardiac reflex was highest during traction of the levator palpebrae muscle.

Conclusions

During ptosis operation under local anesthesia, oculocardiac reflex can occur. Gentle manipulation of surgical tissues and cardiac monitoring is needed to prevent side effects from oculocardiac reflex.

Keywords: Blepharoplasty, Oculocardicac reflex, Ptosis operation

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Figure 1.

Incidence of oculocardiac reflex according to surgical procedures.

1, local anesthetics injection; 2, skin incision; 3, central fat pad traction; 4, medial fat pad traction; 5, levator palpebrae muscle traction.

Table 1.

Mean heart rate according to surgical procedures (Mean±SD)

Procedure	Mean heart rate (beats/min)	p-value^*
Preoperative	76.06±11.24
Local anesthetics injection	74.81±12.64	0.135
Skin incision	74.73±12.20	0.077
Central fat pad traction	73.63±11.73	0.001
Medial fat pad traction	73.35±12.24	0.001
Levator palpebrae muscle traction	71.44±11.93	0.000

^* p-value that intraoperative heart rate was compared with preoperative heart rate.

Table 2.

Occurrence of oculocardiac reflex according to gender

Gender	Number of eyes (%)
Gender	OCR^* (+)	OCR^* (-)	Total
Male	11 (55.0)	9 (45.0)	20 (100)
Female	13 (40.6)	19 (39.4)	32 (100)

Chi-square (p-value)=1.023 (0.312).

^* Oculocardiac reflex.

Table 3.

Comparison of the oculocardiac reflex incidence between right eye and left eye

Eye	Number of eyes (%)
Eye	OCR^* (+)	OCR^* (-)	Total
Right	11 (44.0)	14 (56.0)	25 (100)
Left	13 (48.1)	14 (51.9)	27 (100)

Chi-square (p-value)=0.090 (0.764).

^* Oculocardiac reflex.

Table 4.

Comparison of mean heart rate according to surgical procedures between positive oculocardiac reflex group and negative oculocardiac reflex group (Mean±SD)

Procedure	Mean heart rate (beats/min)		p-value
Procedure	OCR^* (-)	OCR^* (+)	p-value
Local anestdetics injection	76.18±12.49	66.00±10.41	0.046
Skin incision	75.43±12.53	69.33±8.98	0.256
Central fat pad traction	74.77±11.92	67.38±8.78	0.101
Medial fat pad traction	75.12±12.69	65.90±6.26	0.031
Levator palpebrae muscle traction	72.79±12.93	68.29±9.11	0.187

^* Oculocardiac reflex.

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