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: The scenario describes an abrupt drop in blood pressure during squint surgery exactly when the extraocular muscle is being manipulated. This is the oculocardiac reflex: trigeminal afferents and vagal efferents causing bradycardia and hypotension. Step 2: Standard management is stepwise. The very first action is to stop the provoking stimulus, so the anaesthetist instructs the surgeon to release the muscle traction; the reflex typically settles immediately once the stimulus is removed. Step 3: Only if the bradycardia does not recover is intravenous atropine used, along with checking ventilation and depth of anaesthesia. Adrenaline is reserved for true hypotensive or arrest situations and is not the appropriate drug for a reflex bradycardia. Step 4: Therefore, the best immediate management is to ask the surgeon to stop the surgery and release traction. The printed key (give adrenaline) is medically incorrect for the oculocardiac reflex. \[\boxed{\text{Ask the surgeon to stop the surgery}}\]