OCULOCARDIAC REFLEX IN OPHTHALMIC AND NON-OPHTHALMIC SURGERY: EPIDEMIOLOGY, MECHANISMS, PREVENTION AND MANAGEMENT
DOI:
https://doi.org/10.56238/levv16n55-018Keywords:
Arritmias Cardíacas, Anesthesia, Ophthalmologic Surgical Procedures, Cardiac ArrhythmiasAbstract
Introduction: The oculocardiac reflex is a trigeminovagal response that may occur during ophthalmic and non-ophthalmic procedures involving manipulation of orbital structures, leading to bradycardia, arrhythmias, or hemodynamic instability. Its clinical relevance spans pediatric and adult surgery, requiring coordinated preventive and therapeutic strategies.
Objective: The objective of this systematic review was to assess the epidemiology, mechanisms, preventive strategies, and management approaches for the oculocardiac reflex in ophthalmic and non-ophthalmic surgeries. Secondary objectives included evaluating risk factors, comparing anesthetic techniques, analyzing clinical outcomes, identifying gaps in the literature, and proposing implications for clinical practice.
Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies included human or animal research published in the last five years, with extension to ten years only if fewer than ten eligible studies were found. Inclusion criteria encompassed observational studies, randomized trials, and experimental investigations addressing the reflex in surgical settings. Data extraction and study selection followed PRISMA guidelines, with independent reviewers assessing risk of bias using RoB 2, ROBINS-I, and QUADAS-2. Certainty of evidence was graded using GRADE.
Results and Discussion: A total of 18 studies met the eligibility criteria and were included in the final analysis. These studies collectively demonstrated that the incidence of the reflex varies widely by procedure type, age group, anesthetic depth, and surgical technique. Evidence supported multifactorial prevention involving adequate anesthesia, optimized ventilation, and selective use of anticholinergics. Management algorithms consistently emphasized immediate cessation of the triggering stimulus and pharmacologic intervention when necessary. Despite heterogeneity across studies, the overall certainty of evidence ranged from low to moderate.
Conclusion: Current evidence reinforces that the oculocardiac reflex remains a clinically significant phenomenon requiring proactive prevention and rapid intraoperative recognition. Standardized perioperative protocols and improved methodological quality in future studies may enhance safety and guide individualized risk-based management strategies.
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