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- W2003642755 abstract "We read with great interest Gupta’s recent study [1] where patients were randomly allocated to either peribulbar block or topical lidocaine combined with general anaesthesia, or general anaesthesia alone, investigating the oculo-cardiac reflex during strabismus surgery. The study is certainly a step in the right direction, as the authors demonstrated a significantly reduced incidence and severity of the oculo-cardiac reflex, part of the trigemino-cardiac reflex. The study also demonstrates the common problem of prophylaxis in the prevention of the intra-operative trigemino-cardiac reflex [2–5]. Gupta et al. found a high incidence of trigemino-cardiac reflex in their control group. This can be explained by the large number of factors that increase its risk [6]. Examples include hypercarbia, hypoxemia, light anaesthesia, young age, pharmacological, potent narcotics (e.g. sufentanil or alfentanil), calcium channel blockers, and the nature of the provoking stimulus. Several pharmacological substances (e.g. gallamine, atropine) have been found already to more or less prevent the occurrence of this reflex during eye surgery [2, 7], but no substance alone has completely suppressed it. A combination of intravenous atropine blocking the myocardial peripheral muscarinic receptor combined with retrobulbar xylocaine hydrochloride blocking conduction at the ciliary ganglion in the afferent limb of the trigemino-cardiac reflex, is effective in controlling it during eye surgery [8]. Gupta’s current results [1] do not justify the routine use of peribulbar block in paediatric anaesthesia to prevent the trigemino-cardiac reflex. The potential usefulness of this technique is much smaller (especially in strabismus surgery), than the potential harmful side effects (e.g. persistent diplopia through direct damage to the inferior rectus muscle)." @default.
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- W2003642755 date "2008-09-05" @default.
- W2003642755 modified "2023-10-17" @default.
- W2003642755 title "Peribulbar block or topical application of local anaesthesia combined for paediatric strabismus surgery" @default.
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- W2003642755 doi "https://doi.org/10.1111/j.1365-2044.2008.05693_1.x" @default.
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