Arnold Robert W, Farah Richard F, Monroe Gary
Pediatric Ophthalmology and Strabismusm, Ophthalmic Associates, Anchorage, Alaska, USA.
Binocul Vis Strabismus Q. 2002;17(4):313-8.
Bradycardia during strabismus surgery is reduced better by intravenous than by intramuscular (deltoid) anticholinergics, but recent studies suggest that injection into the tongue works faster than into the deltoid. We sought to study this using the suppression of the oculocardiac reflex during eye surgery as a parameter.
804 children and adults underwent calibrated extraocular muscle tensioning during controlled, inhalational general anesthesia. A systemic anticholinergic agent was distributed by different routes to patient-subject sub-groups: preoperative oral, or induction intravenous, intramuscular (deltoid) and intraglossal (submucosal at the base of the tongue). A large control group received no anticholinergic.
The control group had an oculocardiac reflex averaging 17.2% heart rate reduction (bradycardia), 6% of whom had greater than a 50% heart rate reduction. This oculocardiac reflex bradycardia was reduced to only a 6.7% heart rate reduction by oral and intradeltoid routes and was essentially eliminated by both intravenous (-2.3%) and intraglossal (-0.9%) routes.
Intraglossal atropine is an effective alternative for oculocardiac reflex prophylaxis when intravenous access is not readily available in strabismus surgery. The intraglossal route is in fact slightly more effective in this regard that the intravenous route per se.
斜视手术期间，静脉注射抗胆碱能药物比肌肉注射（三角肌）抗胆碱能药物能更好地减轻心动过缓，但最近的研究表明，经舌注射比经三角肌注射起效更快。我们试图以眼科手术期间眼心反射的抑制作为参数来研究这一点。
804名儿童和成人在可控的吸入性全身麻醉下进行校准的眼外肌拉紧。将一种全身性抗胆碱能药物通过不同途径给予患者亚组：术前口服、诱导期静脉注射、肌肉注射（三角肌）和舌内注射（舌根部黏膜下）。一个大的对照组未接受抗胆碱能药物。
对照组的眼心反射平均使心率降低17.2%（心动过缓），其中6%的患者心率降低超过50%。口服和三角肌内注射途径仅将这种眼心反射性心动过缓降低至心率降低6.7%，而静脉注射（-2.3%）和舌内注射（-0.9%）途径基本消除了这种心动过缓。
在斜视手术中，当难以建立静脉通路时，舌内注射阿托品是预防眼心反射的一种有效替代方法。事实上，在这方面舌内注射途径比静脉注射途径本身略有效。
