Question:hard
During squint surgery, the anaesthesiologist notices on the monitor that the blood pressure (and heart rate) suddenly drops to a dangerously low level. What is the best immediate management?
During squint surgery, the anaesthesiologist notices on the monitor that the blood pressure (and heart rate) suddenly drops to a dangerously low level. What is the best immediate management?
Show Hint
Vagal bradycardia from eye-muscle traction needs an antimuscarinic.
Updated On: Jun 24, 2026
- Give atropine
- Increase the level of anaesthesia
- Ask the surgeon to stop the surgery
- Give adrenaline
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Name the event. Abrupt bradycardia and hypotension while the eye muscles are being handled is the textbook oculocardiac reflex. Pulling on an extraocular muscle sends signals up the trigeminal nerve and the vagus nerve then slows the heart.
Step 2: Stop the stimulus. The very first move is to have the surgeon stop the muscle traction, since removing the trigger often reverses the reflex on its own.
Step 3: Give the antidote. When the slow heart and low pressure continue, intravenous $atropine$ is administered. As a vagolytic, atropine blocks the parasympathetic outflow to the heart and quickly brings the rate and pressure back up.
Step 4: Discard adrenaline. Adrenaline is not the standard answer for this vagally driven reflex, so the printed key is incorrect. Increasing anaesthetic depth would not counter the vagal bradycardia either. The correct definitive drug is atropine.
\[\boxed{\text{Give atropine}}\]
Step 2: Stop the stimulus. The very first move is to have the surgeon stop the muscle traction, since removing the trigger often reverses the reflex on its own.
Step 3: Give the antidote. When the slow heart and low pressure continue, intravenous $atropine$ is administered. As a vagolytic, atropine blocks the parasympathetic outflow to the heart and quickly brings the rate and pressure back up.
Step 4: Discard adrenaline. Adrenaline is not the standard answer for this vagally driven reflex, so the printed key is incorrect. Increasing anaesthetic depth would not counter the vagal bradycardia either. The correct definitive drug is atropine.
\[\boxed{\text{Give atropine}}\]
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