Oculocardiac reflex: Difference between revisions
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The '''oculocardiac reflex''', also known as '''Aschner phenomenon''', '''Aschner reflex''', or '''Aschner-Dagnini reflex''', is a decrease in [[pulse rate]] associated with [[traction]]{{Disambiguation needed|date=March 2012}} applied to [[extraocular muscles]] and/or compression of the [[human eyeball|eyeball]]. The reflex is mediated by nerve connections between the ophthalmic branch of the [[trigeminal cranial nerve]] via the [[ciliary ganglion]], and the [[vagus nerve]] of the [[parasympathetic nervous system]]. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented.<ref>{{cite journal | author = Lang S, Lanigan D, van der Wal M | title = Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. | journal = Can J Anaesth | volume = 38 | issue = 6 | pages = 757–60 | year = 1991 | pmid = 1914059 | doi = 10.1007/BF03008454}}</ref> These afferents synapse with the [[visceral motor nucleus]] of the vagus nerve, located in the [[reticular formation]] of the brain stem. The efferent portion is carried by the vagus nerve from the [[cardiovascular center]] of the [[Medulla oblongata|medulla]] to the heart, of which increased stimulation leads to decreased output of the [[sinoatrial node]].<ref>{{cite journal | author = Paton J, Boscan P, Pickering A, Nalivaiko E | title = The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. | journal = Brain Res Brain Res Rev | volume = 49 | issue = 3 | pages = 555–65 | year = 2005 | pmid = 16269319 | doi = 10.1016/j.brainresrev.2005.02.005}}</ref> This reflex is especially sensitive in [[neonates]] and children, particularly during [[strabismus |
The '''oculocardiac reflex''', also known as '''Aschner phenomenon''', '''Aschner reflex''', or '''Aschner-Dagnini reflex''', is a decrease in [[pulse rate]] associated with [[traction]]{{Disambiguation needed|date=March 2012}} applied to [[extraocular muscles]] and/or compression of the [[human eyeball|eyeball]]. The reflex is mediated by nerve connections between the ophthalmic branch of the [[trigeminal cranial nerve]] via the [[ciliary ganglion]], and the [[vagus nerve]] of the [[parasympathetic nervous system]]. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented.<ref>{{cite journal | author = Lang S, Lanigan D, van der Wal M | title = Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. | journal = Can J Anaesth | volume = 38 | issue = 6 | pages = 757–60 | year = 1991 | pmid = 1914059 | doi = 10.1007/BF03008454}}</ref> These afferents synapse with the [[visceral motor nucleus]] of the vagus nerve, located in the [[reticular formation]] of the brain stem. The efferent portion is carried by the vagus nerve from the [[cardiovascular center]] of the [[Medulla oblongata|medulla]] to the heart, of which increased stimulation leads to decreased output of the [[sinoatrial node]].<ref>{{cite journal | author = Paton J, Boscan P, Pickering A, Nalivaiko E | title = The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. | journal = Brain Res Brain Res Rev | volume = 49 | issue = 3 | pages = 555–65 | year = 2005 | pmid = 16269319 | doi = 10.1016/j.brainresrev.2005.02.005}}</ref> This reflex is especially sensitive in [[neonates]] and children, particularly during [[Strabismus surgery|strabismus correction surgery]].<ref>{{cite journal | author = Kim H, Kim S, Kim C, Yum M | title = Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children. | journal = Anaesthesia | volume = 55 | issue = 9 | pages = 847–52 | year = 2000 | pmid = 10947746 | doi = 10.1046/j.1365-2044.2000.01158.x}}</ref> However, this reflex may also occur with adults. [[Bradycardia]], junctional rhythm and [[asystole]], all of which may be life-threatening,<ref>{{cite journal | author = Smith R | title = Death and the oculocardiac reflex. | journal = Can J Anaesth | volume = 41 | issue = 8 | pages = 760 | year = 1994 | pmid = 7923532 | doi = 10.1007/BF03015643}}</ref> can be induced through this reflex. |
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==Treatment== |
==Treatment== |
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Revision as of 00:51, 18 July 2014
The oculocardiac reflex, also known as Aschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction[disambiguation needed] applied to extraocular muscles and/or compression of the eyeball. The reflex is mediated by nerve connections between the ophthalmic branch of the trigeminal cranial nerve via the ciliary ganglion, and the vagus nerve of the parasympathetic nervous system. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented.[1] These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent portion is carried by the vagus nerve from the cardiovascular center of the medulla to the heart, of which increased stimulation leads to decreased output of the sinoatrial node.[2] This reflex is especially sensitive in neonates and children, particularly during strabismus correction surgery.[3] However, this reflex may also occur with adults. Bradycardia, junctional rhythm and asystole, all of which may be life-threatening,[4] can be induced through this reflex.
Treatment
The reflex can be blocked by injecting peribulbar or retrobulbar local anesthetics prior to stimulation, or with intravenous injection of an anti-muscarinic acetylcholine (ACh) antagonist, such as atropine or glycopyrrolate. If bradycardia does occur, removal of the stimulus is immediately indicated. This often results in the restoration of normal sinus rhythm of the heart. If not, the use of atropine or glycopyrrolate will usually be successful and permit continuation of the surgical procedure. In extreme cases, such as asystole, cardiopulmonary resuscitation may be required.
References
- ^ Lang S, Lanigan D, van der Wal M (1991). "Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex". Can J Anaesth. 38 (6): 757–60. doi:10.1007/BF03008454. PMID 1914059.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Paton J, Boscan P, Pickering A, Nalivaiko E (2005). "The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited". Brain Res Brain Res Rev. 49 (3): 555–65. doi:10.1016/j.brainresrev.2005.02.005. PMID 16269319.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Kim H, Kim S, Kim C, Yum M (2000). "Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children". Anaesthesia. 55 (9): 847–52. doi:10.1046/j.1365-2044.2000.01158.x. PMID 10947746.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Smith R (1994). "Death and the oculocardiac reflex". Can J Anaesth. 41 (8): 760. doi:10.1007/BF03015643. PMID 7923532.
External links
- Reflex,+Oculocardiac at the U.S. National Library of Medicine Medical Subject Headings (MeSH)