Oculocardiac reflex incidence in post-traumatic orbital reconstruction surgery

Abstract

The oculocardiac reflex (OCR) is a well-recognised phenomenon characterised by cardiac arrhythmia precipitated by various electrical, physical or chemical stimuli to branches of the trigeminal nerve. The reported incidence rate varies widely and specifically following post-trauma orbital reconstruction in the adult population has not been clearly defined. We reviewed a continuous case series of 100 patients who underwent post-traumatic orbital reconstruction to investigate the incidence of OCR in this population. Variables recorded included age, gender, American Society of Anaesthesiologists physical status (ASA), regular medications of relevance, fracture subtype, number of intraoperative OCR events, intraoperative medical management, and primary surgeon experience level. The overall incidence of OCR in this cohort was 48.4%. Increasing fracture complexity was associated with an increased risk of OCR (OR 4.378, 95% CI: 1.023 to 18.730, p = 0.046). Age, gender, ASA, regular medications of relevance and primary surgeon experience did not have a statistically significant effect on the incidence of an OCR. Our study indicates that the OCR is a common phenomenon during post-trauma orbital reconstruction. Further studies may be warranted to further recognise at-risk patients, to identify ideal management strategies.