Oculocardiac reflex

A peculiarity of ophthalmic anaesthesia but also possible in entrapment after orbital floor fracture
Stimulus pressure or traction on eyeball
Afferent CN V (ciliary nerves) → ciliary ganglion → Gasserion ganglion → trigeminal nucleus
Efferent vagus nerve → SA node
Response ↑ vagal tone
Net effect Bradycardia/AV block

anaesthetic considerations

  • Effect increased by:
    • TIVA
    • dexmed
    • hypoxia, hypercarbia