Grover V K, Bhardwaj N, Shobana N, Grewal S P
Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ophthalmic Surg Lasers. 1998 Mar;29(3):207-12.
This study was designed to examine the effects of local and general anesthesia on the oculocardiac reflex (OCR) in adults during retinal detachment surgery, with an aim of determining the safest type of anesthesia and on which extraocular muscle traction causes a higher incidence of OCR.
The study was performed on 30 American Society of Anesthesiologists-I patients (age range 40-60 years) who were undergoing retinal detachment surgery. Fifteen patients underwent surgery with general anesthesia and 15 were given a local peribulbar block. A fixed traction of 400 g was applied to all the extraocular muscles, and the heart rate, rhythm, and electrocardiogram of each patient was monitored.
The overall incidence of OCR was higher with general anesthesia (63.3%) than with local anesthesia (14.4%). There was a significant decrease in heart rate for the rectus muscles (P < .0005) as well as the oblique muscles (P < .005) during traction with general anesthesia. All four rectus muscles were equally sensitive in eliciting the reflex. The incidence of dysrhythmias was 20% with general anesthesia and 6.67% with local anesthesia.
This study showed that local anesthesia produces less bradycardia and ectopic arrhythmias and, therefore, may be safer and better than general anesthesia for surgeries in which traction of extraocular muscles is required.
本研究旨在探讨局部麻醉和全身麻醉对成人视网膜脱离手术中眼心反射（OCR）的影响，以确定最安全的麻醉方式以及哪种眼外肌牵引会导致更高的眼心反射发生率。
本研究对30例美国麻醉医师协会分级为I级（年龄范围40 - 60岁）且正在接受视网膜脱离手术的患者进行。15例患者接受全身麻醉手术，15例接受局部球周阻滞麻醉。对所有眼外肌施加400克的固定牵引力，并监测每位患者的心率、心律和心电图。
全身麻醉时眼心反射的总体发生率（63.3%）高于局部麻醉（14.4%）。全身麻醉牵引期间，直肌（P <.0005）和斜肌（P <.005）的心率均显著下降。所有四条直肌引发反射的敏感性相同。全身麻醉时心律失常的发生率为20%，局部麻醉时为6.67%。
本研究表明，局部麻醉引起的心动过缓和异位心律失常较少，因此对于需要牵引眼外肌的手术，局部麻醉可能比全身麻醉更安全、更好。
