Incidence and risk factors of oculocardiac reflex during Inferior rectus muscle recession under general anesthesia in thyroid eye disease

Abstract

Purpose

To investigate the incidence and risk factors of oculocardiac reflex (OCR) during inferior rectus (IR) muscle recession under general anesthesia in patients with thyroid eye disease (TED).

Methods

This retrospective study included 68 patients with TED who underwent IR muscle recession. Demographic, imaging, surgical, and anesthetic data were analyzed. OCR was defined as a heart rate decrease of > 20% from baseline during surgery. Logistic regression was used to assess risk factors.

Results

OCR occurred in 14 patients (20.6%). Logistic regression analysis identified the presence of intramuscular fat degeneration as a significant factor to reduce the risk of OCR (odds ratio, 0.010; P = 0.014). Additionally, patients with OCR had a higher baseline heart rate compared to those without OCR (65.4 ± 12.4 bpm vs. 57.8 ± 8.9 bpm; P = 0.031), but the result of logistic regression analysis did not reach the statistical significance (odds ratio, 1.128; P = 0.088). No association was found between OCR and other variables.

Conclusion

The absence of intramuscular fat degeneration significantly increases the risk of OCR during IR muscle recession under general anesthesia in TED. These findings provide valuable insights for perioperative strategies to improve safety in strabismus surgeries for TED.