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The effect of long term treatment with betablockers in increasing the incidence of bradycardia in patients undergoing posterior segment eye surgeries

Mohammad Ramadan , Bassant Mohammad , Karim Hussein , Ahmed Nabih , Abdelrazek Ahmed


Background: The oculocardiac reflex (OCR) is of importance to both oph¬thalmologists and anaesthetists because it may lead to serious bradycardia during ophthalmic surgery. Methods: Sixty adult patients, of both sexes, with the age range of between 18-70 years, were scheduled for the elective or urgent posterior segment eye surgery under general anesthesia. This was a prospective observational study in a patients’ group under the chronic use of beta blocker who were screened for the development of OCR. OCR has been defined as a significant bradycardia (40% below the preoperative heart rate for 10 minutes), dysrhythmias (recorded by ECG intraoperatively) with or without hypotension defined as a decrease in the systolic blood pressure more than 30%. OCR was managed by the cessation of the surgical stimulus either alone or by IV administration of 0.5 mg atropine in increment with a maximum 2mg.

Results: Only two patients developed OCR that was defined as a significant bradycardia (40% below preoperative heart rate for 10 minutes), dysrhythmias (recorded by ECG intraoperatively). The patients developed only one episode throughout the operation, and they were managed by the cessation of surgical stimulus by iv atropine (0.5 mg) twice [total 1 mg], and recovered. Conclusion: This study showed that patients on long term uses of beta blockers had no increased risk for the occurrence of oculocardiac Reflex.

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