Question

During squint surgery the anaesthesiologist sees the blood pressure suddenly drop to 40. What is the best immediate management?

• A. Give atropine
• B. Increase level of anaesthesia
• C. Ask the surgeon to stop the surgery
• D. Give adrenaline

Hint:

Oculocardiac reflex - first remove the stimulus by stopping traction.

Answer 1

The Correct Option is C

Step 1: A sudden cardiovascular collapse during strabismus (squint) surgery, triggered while the surgeon is pulling on an extraocular muscle, is the classic oculocardiac reflex (Aschner reflex). The afferent limb is the trigeminal nerve and the efferent limb is the vagus, producing bradycardia and a fall in blood pressure. Step 2: The single most important and immediate step is to remove the trigger, so you ask the surgeon to stop the surgery and release traction on the muscle; this alone usually reverses the reflex at once. Step 3: If bradycardia persists after traction is released, intravenous atropine is given as an antivagal (anticholinergic) drug. Deepening anaesthesia and ensuring adequate ventilation also help. Step 4: Adrenaline is not the correct first response to a vagally mediated bradycardia and may be harmful, so the best immediate management is option c, asking the surgeon to stop.