THE INTRAOPERATIVE OCULOCARDIAC REFLEX AS A PREDICTOR OF POSTOPERATIVE VASO-VAGAL RESPONSES DURING ADJUSTABLE SUTURE SURGERY

Adjustable suture surgery has become a popular method of strabismus co rrection in those cases in which results are less predictable, such as reoperations, thyroid ophthalmopathy, and blind eyes. Complications r elated to adjustable strabismus surgery are, in general, no different than those related to standard surgical techniques. We noticed a subgr oup of patients who experienced significant vaso-vagal responses (V-VR ) during postoperative adjustment and sought to discover a method of i dentifying these patients prior to adjustment. Sixty patients were stu died prospectively from July 1991 to July 1992. All patients had surge ry under general anesthesia and were adjusted 24 hours later. A positi ve oculocardiac reflex (OCR) occurred when a 10% or greater intraopera tive change in heart rate was associated with traction on an extraocul ar muscle. A positive V-VR postoperatively consisted of one or more su bjective findings (dizziness, light-headedness, nausea, or body temper ature changes), and two or more objective findings (10% or greater cha nge in heart rate, hypotension, pallor, diaphoresis, vomiting, disorie ntation, or loss of consciousness). Variables studied for predictive v alue included OCR, age, sex, strabismus type, previous surgery, muscle adjusted, and systemic disease. Twenty-five patients (41.6%) had a po sitive V-VR during adjustment. Twenty-seven patients (45%) had a posit ive OCR. Eighty-five percent of patients with a positive OCR and 9% of patients with a negative OCR had a positive V-VR. Younger patients we re also more likely to have a positive V-VR. A positive intraoperative OCR under general anesthesia during strabismus surgery is highly pred ictive of a postoperative V-VR during planned adjustment.