Bengü Gülhan AYDIN, Gamze KÜÇÜKOSMAN, Özcan PİŞKİN, Bahar AKTAŞ, Rahşan Dilek OKYAY, Silay Cantürk UĞURBAŞ, Hilal AYOĞLU

Factors Affecting Oculocardiac Reflex Incidence in Pediatric Strabismus Surgery: Retrospective Study

Objective: Oculocardiac reflex (OCR) activation is common during strabismus surgery. As a resultof OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole mayoccur. Pediatric patients are also more vulnerable to the harmful effects of this reflex. The aim ofthis study was to determine the possible risk factors affecting the incidence of OCR in pediatricpatients undergoing strabismus surgery.Method: The medical records of the pediatric patients who underwent strabismus surgerybetween January 2015 and September 2018 were retrospectively reviewed. The operations performed by the same surgeon were included in the study. OCR was defined as a more than 20%reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR,anesthesia management, neuromuscular blocker and anesthetic drugs used for anesthesia induction and maintenance as well as airway management, the number of operated eyes, and also themuscle types of the patients were all recorded. Risk factors for OCR were evaluated by logisticregression analysis.Results: Out of 92 pediatric patients who were initially evaluated, six were excluded from thestudy because their files were missing. A total of 86 patients were included in the study. Duringsurgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine forpremedication (p=0.03) and nonuse of neuromuscular blocker after induction (p=0.046) in pediatric patients have been specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11times, respectively.Conclusion: The incidence of OCR may be reduced with preventive measures such as applicationof neuromuscular blocker, and premedication with benzodiazepine in strabismus surgeries.

Pediyatrik Şaşılık Cerrahisinde Okülokardiyak Refleks İnsidansını Etkileyen Faktörler: Retrospektif Çalışma

Amaç: Şaşılık cerrahisi sırasında okülokardiyak refleks (OKR) aktivasyonu yaygındır. OKR sinüs bradikardisi, atriyoventriküler blok, ventriküler fibrilasyon ve hatta asistol ile sonuçlanabilir. Pediyatrik hastalar bu refleksin zararlı etkilerine karşı daha savunmasızdır Bu çalışmada şaşılık cerrahisi geçiren pediyatrik hastalarda OKR insidansını etkileyen olası risk faktörlerini belirlemek amaçlandı. Yöntem: Ocak 2015-Eylül 2018 tarihleri arasında şaşılık cerrahisi geçiren pediyatrik hastaların kayıtları retrospektif olarak incelendi. Sadece tek bir cerrah tarafından yapılan ameliyatlar dahil edildi. OKR; ekstraoküler kas (EOK) manipülasyonunun neden olduğu kalp hızında %20’den fazla azalma olarak tanımlandı. Hastaların demografik verileri, cerrahi süre, önceden geçirilmiş şaşılık cerrahisi öyküsü, OKR gelişip gelişmediği, anestezi yönetimi; indüksiyon ve idamede kullanılan kas gevşeticiler ve anestezik ilaçlarının yanı sıra hava yolu yönetimi , opere edilen göz sayısı ve kas tipi kaydedildi. OKR için risk faktörleri lojistik regresyon analizi ile değerlendirildi. Bulgular: Başlangıçta değerlendirilen 92 pediyatrik hastadan, altısının dosyası eksik olduğu için çalışma dışı bırakıldı. Toplam 86 hasta çalışmaya dahil edildi. Ameliyat sırasında 29 hastada (%33.7) OKR görülmüştür. Pediyatrik hastalarda premedikasyonda benzodiyazepin (p=0.03) ve indüksiyon sonrası kas gevşetici uygulanmamış olması (p=0.046) bağımsız risk faktörleri olarak belirlenmiştir. Kas gevşetici kullanımının ve premedikasyonda benzodiyazepin uygulanmasının OKR riskini sırasıyla 3.64 ve 3.11 kat azalttığını bulduk. Sonuç: Şaşılık cerrahilerinde OKR insidansı kas gevşetici uygulanması, benzodiyazepin ile premedikasyon gibi önleyici tedbirlerle azaltılabilir

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