J Korean Assoc Oral Maxillofac Surg.  2021 Aug;47(4):335-336. 10.5125/jkaoms.2021.47.4.335.

Oculocardiac reflex: an unusual trigger during dental surgery

• Arora V
• Lee A

• KMID: 2519831
• DOI: http://doi.org/10.5125/jkaoms.2021.47.4.335

Abstract

The oculocardiac reflex is a trigeminal-vagal reflex that manifests as cardiac arrythmias, most often bradycardia. The reflex can be triggered by manipulation of periorbital structures and unintended pressure on the bulbus oculi maxillofacial procedures. In this brief communication, we describe an unusual trigger of the oculocardiac reflex during maxillofacial surgery that resulted in severe bradycardia. This case highlights the need for careful securement of medical devices and attention to surgical technique to avoid undue pressure on draped fascial structures.

Keyword

Nasotracheal tube; Bradycardia; Oculocardiac reflex

Figure

• 

  Fig. 1 A. A folded surgical towel is placed on the forehead to support the Ring-Adair-Elwyn (RAE) tube. B. The folded towel is noted to have slipped (arrow) from under the RAE tube into the orbital cavity transmitting pressure from the surgeon’s hand above the drapes on to the globe.

Reference

References

1. Brasileiro BF, Sickels JEV, Cunningham LL. 2020; Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis. J Korean Assoc Oral Maxillofac Surg. 46:428–34. https://doi.org/10.5125/jkaoms.2020.46.6.428 . DOI: 10.5125/jkaoms.2020.46.6.428. PMID: 33377469. PMCID: PMC7783186.

2. Doyle DJ, Mark PW. 1990; Reflex bradycardia during surgery. Can J Anaesth. 37:219–22. https://doi.org/10.1007/BF03005473 . DOI: 10.1007/BF03005473. PMID: 2088315.

3. Yamamoto T, Flenner M, Schindler E. 2019; Complications associated with nasotracheal intubation and proposal of simple countermeasure. Anaesthesiol Intensive Ther. 51:72–3. https://doi.org/10.5603/AIT.a2019.0002 . DOI: 10.5603/AIT.a2019.0002. PMID: 30723887.

4. Farbod F, Tuli P, Robertson BF, Jackson IT. 2010; Endotracheal tube fixation methods for optimal stability: a comparison of adhesive tape, suture, and tape-suture fixation. J Craniofac Surg. 21:1250–1. https://doi.org/10.1097/SCS.0b013e3181e20860 . DOI: 10.1097/SCS.0b013e3181e20860. PMID: 20613600.