• Seong-Won Min and Jeong-Min Hwang.
• Department of Anesthesiology, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
• Graefes Arch. Clin. Exp. Ophthalmol. 2011 Dec 1;249(12):1889-92.

PurposeTo investigate whether patients who developed asystole during strabismus surgery under general anesthesia also develop asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients.DesignRetrospective, noncomparative interventional case series.MethodsAdjustment was performed with topical anesthesia in four patients aged 28, 32, 50, and 53 years who exhibited asystole during strabismus surgery under general anesthesia. Blood pressure and electrocardiogram were monitored during the adjustment.ResultsAdjustment was successfully completed in all patients without asystole. Two patients showed oculocardiac reflex (OCR), with a reduction in heart rate (HR) >20% of the baseline value. One of these patients exhibited severe OCR that developed when the patient's posture was changed from the supine to the sitting position for measurement of the angle of strabismus after adjustment, and again during conjunctival manipulation after conjunctival closure. No patient required atropine.ConclusionsAdjustment can safely be performed under topical anesthesia in patients who developed asystole during strabismus surgery under general anesthesia.

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