title: The attenuating effect of intraglossal atropine on the oculocardiac reflex.
abstract: BACKGROUND
  Bradycardia during strabismus surgery is reduced better by intravenous than by intramuscular (deltoid) anticholinergics, but recent studies suggest that injection into the tongue works faster than into the deltoid. We sought to study this using the suppression of the oculocardiac reflex during eye surgery as a parameter.
  
  
  METHODS
  804 children and adults underwent calibrated extraocular muscle tensioning during controlled, inhalational general anesthesia. A systemic anticholinergic agent was distributed by different routes to patient-subject sub-groups: preoperative oral, or induction intravenous, intramuscular (deltoid) and intraglossal (submucosal at the base of the tongue). A large control group received no anticholinergic.
  
  
  RESULTS
  The control group had an oculocardiac reflex averaging 17.2% heart rate reduction (bradycardia), 6% of whom had greater than a 50% heart rate reduction. This oculocardiac reflex bradycardia was reduced to only a 6.7% heart rate reduction by oral and intradeltoid routes and was essentially eliminated by both intravenous (-2.3%) and intraglossal (-0.9%) routes.
  
  
  CONCLUSIONS
  Intraglossal atropine is an effective alternative for oculocardiac reflex prophylaxis when intravenous access is not readily available in strabismus surgery. The intraglossal route is in fact slightly more effective in this regard that the intravenous route per se.
authors.affiliation: Pediatric Ophthalmology and Strabismusm, Ophthalmic Associates, Anchorage, Alaska, USA. eyedoc@alaska.net
authors.forename: Robert W
authors.initials: RW
authors.lastname: Arnold
authors.forename: Richard F
authors.initials: RF
authors.lastname: Farah
authors.forename: Gary
authors.initials: G
authors.lastname: Monroe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004333:Drug Administration Routes; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D009801:Oculomotor Muscles / Q000601:surgery*; D011446:Prospective Studies; D012024:Reflex, Oculocardiac / Q000187:drug effects*; D013285:Strabismus / Q000601:surgery*; D014059:Tongue / Q000187:drug effects*
chemical_list: D018727:Muscarinic Antagonists; D001285:Atropine