Neuromuscular Blockade Depth and Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial.
Deeper neuromuscular blockade reduced oculocardiac reflex during pediatric strabismus surgery.
Neuromuscular Blockade Depth and Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial.
Although neuromuscular blockade reduces oculocardiac reflex (oculocardiac reflex) incidence compared with no neuromuscular blockade, the effect of blockade depth on oculocardiac reflex has not been prospectively evaluated.
This study aimed to evaluate whether the depth of neuromuscular blockade influences the incidence of the oculocardiac reflex during pediatric strabismus surgery.
In this prospective, double-blinded randomized controlled trial, 204 pediatric patients aged 3 to 18 years undergoing strabismus surgery under general anesthesia were randomly assigned to moderate-to-deep neuromuscular blockade (MD-NMB; train-of-four count 0-3) or minimal-to-shallow neuromuscular blockade (MS-NMB; train-of-four count 4 with ratio <0.9).
deeper muscle relaxation meant fewer heart-rate drops from eye-muscle tugging
37.0s [17.0-49.5s]; p=0.024) of heart rate reduction were smaller in the MD-NMB group.
Moderate to deep neuromuscular blockade significantly reduced both the incidence and severity of oculocardiac reflex during pediatric strabismus surgery compared with minimal to shallow blockade.
These findings suggest that deeper neuromuscular blockade may represent an effective strategy to attenuate oculocardiac reflex during extraocular muscle manipulation.