ePoster 55

Mar 04, 2017 by AAPOS editor in  e-Poster session 2

Dexmetadomidine (Precedex) Increases Oculocardiac Reflex

Robert W. Arnold; Russell Biggs; Brion Beerle

Alaska Children’s EYE & Strabismus
Anchorage, Alaska

Introduction:  The only substances known to increase oculocardiac reflex (OCR) are fast-acting opioids(1).  Last year, we reported that premedication with nasal dexmetadomidine (Precedex) was associated with more OCR. Therefore, we performed an intra-subject, intravenous comparison to test our hypothesis that this alpha-adrenergic agonist potentiates the trigemino-vagal reflex.

Methods:  In our ongoing, IRB study, OCR is prospectively monitored with 10-second, square wave 200 gram tension on inferior rectus- or other muscles during strabismus surgery. Between the first and second muscle, dexmetadomidine 0.5µg/Kg I.V. was delivered.

Results:  All patients had inferior rectus tension and no anticholinergic.  1399 control patients, media age 5.5 years had first OCR of  -24.2±1.2% and second OCR of -22.7±1.2% with a delta (decrease) of 1.5±1.0%.  The 33 patients study patients, medial age 5.6 years, had first OCR -16.0±5.6% and dexmetadomidine second OCR of -33.8±8.8% for a bradycardia augmentation of 17.8±6.8%  (t-Test p<0.01).

Discussion:  Similar to the impact of fentanyl, dexmetedomidine will increase the bradycardia associated with extra-ocular muscle traction- almost doubling the amount.

Conclusion:  Strabismus surgeons, neonatologists and anesthesiologists need to take precautions when using Precedex.

References:  (1) Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH: Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand 2008, 52(9):1273-1277.

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