PREVENTION OF OCULOCARDIAC REFLEXES DURING ANESTHESIA IN PEDIATRIC OPHTHALMIC SURGERY

Аннотация

The use of general anesthesia is unquestionable in the surgical correction of congenital ophthalmic pathologies occurring in children. Anesthetic approaches employed in these cases are typically aimed at enhancing the quality of surgical interventions. Unlike other branches of ophthalmic surgery, the impact of the anesthetics used on the functional state of the visual organs is of significant importance. Certain anesthetics (ketamine) and agents (muscle relaxants) can increase intraocular pressure during surgery, potentially inducing unexpected adverse effects. Therefore, a tailored approach is essential in selecting anesthetic agents and techniques for surgeries for congenital ophthalmic pathologies in children, aiming to prevent potential complications that may arise during and after surgery. Components of General Anesthesia in Pediatric Ophthalmic Surgery The active development of ophthalmic microsurgery in the last decade has introduced new demands for improving anesthetic management in these procedures. Anesthesia in pediatric ophthalmic surgery necessitates a specialized approach, encompassing the provision of adequate sedation, effective preoperative and postoperative analgesia, prevention of undesirable reflex reactions (oculocardiac, swallowing), reduction of postoperative nausea and vomiting, and prevention of post- anesthetic agitation [1, 2, 3]. Numerous researchers suggest that low-dose ketamine improves the surgical process and reduces the risk of oculocardiac reflex during surgery, while also eliminating the need for atropine administration for OCR prophylaxis. The oculocardiac reflex was first described by Aschner and Dagnini in 1908. It is considered a peripheral type of the trigeminal cardiac reflex (TCR), similar https://scientific-jl.org/obr 1 9 Выпуск журнала №-70 Часть–9_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 to the maxillomandibular cardiac reflex (MMCR). According to Shevchenko Y.L., stimulation of any branch of the trigeminal nerve causes the afferent signal flow to pass from the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, while efferent pathways from the motor nucleus of the vagus nerve are interrupted [3, 4]. Some researchers believe that not only traction of the extraocular muscles or pressure on the eyeball, but also stimulation of the periosteum can lead to cardiac rhythm disturbances, such as bradycardia, AV block, ventricular ectopy, or asystole [9, 10]. The authors also report the risk of temporary cardiac arrest during strabismus surgery as 1 in 2200 cases. It has been shown that even prophylactic atropine administration does not reduce the risk of developing complications [11]. In the field of pediatric ophthalmic anesthesia, it was long considered necessary to premedicate with atropine and seduxen when performing anesthesia with ketamine [1, 2]. However, this option did not fully meet all the requirements set by surgeons, as they aimed to prevent postoperative agitation, excitement, nausea, and vomiting, as these conditions can increase intraocular pressure and, consequently, reduce the effectiveness of the surgical intervention [5]. This combination also creates vagotonic and bronchodilator effects [8, 10], reduces the risk of hypoventilation when used in precise doses [9], and initiates a rapid awakening process with single administration. Joniev S.Sh. and colleagues (2015) discuss propofol, describing it as a drug that fully meets all the requirements for anesthetic management in eye surgery. The authors emphasize that propofol does not increase intraocular pressure, general anesthesia begins at a predictable rate, is stable, and then quickly and smoothly restores consciousness and somatic functions, while strain or vomiting are not observed. Anesthesia combined with propofol creates the most suitable conditions for surgical correction, minimizes the negative effects of its individual components, and maximally ensures the specific tasks of anesthetic management for ophthalmic operations [4]. While ketamine has the most pronounced psychotropic adverse effects, according to, anesthesia combined with propofol affects the psyche through a sedation mechanism, making the ketamine- propofol combination more favorable [5]. In his study on ophthalmic surgery using https://scientific-jl.org/obr 2 0 Выпуск журнала №-70 Часть–9_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 ketamine, sevoflurane, propofol, midazolam, and halothane, found that hemodynamic changes were minimal with ketamine, and the risk of developing oculocardiac reflex was minimal [11]. Autors (2021) recommends conducting anesthesia induction using ketamine and midazolam, and also notes that propofol and remifentanil increase the risk of oculocardiac reflex development [10]. However, in a study by of a combination of propofol, sufentanil, and remifentanil, no adverse complications such as oculocardiac, oculopulmonary, and oculogastric reflexe