Oculocardiac reflex
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2008-05-28T20:57:59Z
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The '''oculocardiac reflex''', also known as '''Aschner phenomenon''', '''Aschner reflex''', or '''Aschner-Dagnini reflex''', is a decrease in [[pulse rate]] associated with [[traction]] applied to [[extraocular muscles]] and/or compression of the [[eyeball]]. The reflex is mediated by nerve connections between the [[trigeminal cranial nerve]] and the [[vagus nerve]] of the [[parasympathetic nervous system]]. The afferent tracts derive mainly from the ophthalmic division of the trigeminal nerve, although tracts from the maxillary and mandibular division have also been documented<ref>{{cite journal | author = Lang S, Lanigan D, van der Wal M | title = Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. | journal = Can J Anaesth | volume = 38 | issue = 6 | pages = 757–60 | year = 1991 | pmid = 1914059}}</ref>. These afferents synapse with the [[visceral motor nucleus]] of the vagus nerve, located in the [[reticular formation]] of the brain stem. The efferent portion is carried by the vagus nerve from the [[cardiovascular center]] of the [[medulla]] to the heart, of which increased stimulation leads to decreased output of the [[sinoatrial node]]<ref>{{cite journal | author = Paton J, Boscan P, Pickering A, Nalivaiko E | title = The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. | journal = Brain Res Brain Res Rev | volume = 49 | issue = 3 | pages = 555–65 | year = 2005 | pmid = 16269319 | doi = 10.1016/j.brainresrev.2005.02.005}}</ref>. This reflex is especially sensitive in [[neonates]] and children, and must be monitored, usually by an [[anaesthesiologist]], during paediatric ophthalmological surgery, particularly during [[strabismus]] correction surgery<ref>{{cite journal | author = Kim H, Kim S, Kim C, Yum M | title = Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children. | journal = Anaesthesia | volume = 55 | issue = 9 | pages = 847–52 | year = 2000 | pmid = 10947746 | doi = 10.1046/j.1365-2044.2000.01158.x}}</ref>. However, this reflex may also occur with adults. [[Bradycardia]], junctional rhythm, [[asystole]], and very rarely death<ref>{{cite journal | author = Smith R | title = Death and the oculocardiac reflex. | journal = Can J Anaesth | volume = 41 | issue = 8 | pages = 760 | year = 1994 | pmid = 7923532}}</ref>, can be induced through this reflex.
==Treatment/prophylaxis==
Removal of the inciting stimulus is immediately indicated, and is essential for successful termination of this reflex. The surgeon, or practitioner, working on the eye should be asked to cease their activity and release the applied pressure or traction on the eyeball. This often results in the restoration of normal sinus rhythm of the heart. If not, the use of an [[anti-muscarinic]] [[acetylcholine]] (ACh) [[antagonist]], such as [[atropine]] or glycopyrolate, will likely successfully treat the patient and permit continuation of the surgical procedure. In extreme cases, such as the development of asystole, aggressive [[cardiopulmonary resuscitation]] may be required.
==References==
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==External links==
* {{MeshName|Reflex,+Oculocardiac}}
{{Reflex}}
[[Category:Ophthalmology]]
[[uk:Рефлекторна регуляція серця]]