Neuromuscular Blockade Depth and Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial.
Jung-Bin Park, Jae Ho Jung, Sang-Hwan Ji et al.
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In 30 seconds
This prospective, double-blinded randomized trial compared moderate-to-deep with minimal-to-shallow neuromuscular blockade in children aged 3 to 18 years undergoing strabismus surgery under general anesthesia. Among 201 analyzed patients, moderate-to-deep blockade was associated with a lower incidence of oculocardiac reflex (OCR) grade 2 or higher, defined as a heart-rate decrease of at least 20%: 30.3% vs. 53.9% (odds ratio, 0.37; 95% CI, 0.21 to 0.66; P = 0.001). Severe OCR and the magnitude and duration of heart-rate reduction among patients with OCR were also lower with deeper blockade.
Key findings
- OCR grade 2 or higher occurred in 30.3% with moderate-to-deep blockade versus 53.9% with minimal-to-shallow blockade (odds ratio, 0.37; 95% CI, 0.21 to 0.66; P = 0.001).
- OCR grade 3 or higher occurred in 18.2% versus 35.3%, respectively (odds ratio, 0.41; 95% CI, 0.21 to 0.78; P = 0.007).
- Among patients who developed OCR, heart-rate reduction was smaller and shorter with moderate-to-deep blockade: 34.3% vs. 28.0% and 46.0 s vs. 37.0 s, respectively.
Why it matters
OCR during extraocular muscle manipulation can involve substantial heart-rate reduction. This randomized comparison indicates that blockade depth is relevant to both the likelihood and severity of OCR in pediatric strabismus surgery, providing evidence to inform anesthetic planning while keeping the finding specific to the studied setting and population.
What to keep in mind
The trial studied pediatric patients undergoing strabismus surgery under general anesthesia; the abstract does not establish whether the findings apply to other populations or procedures.