Special anaesthesia: oculocardiac reflex: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Special anaesthesia: oculocardiac reflex

Sample item

A 6-year-old child undergoing squint surgery develops sudden bradycardia of 40 per minute when the surgeon pulls on the medial rectus. What is the first action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ask the surgeon to stop the traction

Traction on extraocular muscles stimulates trigeminal afferents and causes vagal efferent bradycardia. Releasing the traction usually restores the rate, and IV atropine is given if the bradycardia persists or recurs. Adequate depth of anaesthesia and prophylactic anticholinergics can reduce the reflex.

Option by option

  • A. Start chest compressions

    Compressions are for cardiac arrest, not reflex bradycardia that resolves with release.

  • B. Ask the surgeon to stop the traction (correct)

    Correct. Removing the stimulus is the first and most effective step.

  • C. Increase the depth of anaesthesia with a bolus of propofol

    Deepening anaesthesia does not abolish a reflex vagal response by itself.

  • D. Give IV adrenaline

    Adrenaline is not needed unless the bradycardia persists with circulatory failure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Ask the surgeon to stop the traction. Traction on extraocular muscles stimulates trigeminal afferents and causes vagal efferent bradycardia.

Why is "Start chest compressions" not the answer?

Compressions are for cardiac arrest, not reflex bradycardia that resolves with release.

Why is "Increase the depth of anaesthesia with a bolus of propofol" not the answer?

Deepening anaesthesia does not abolish a reflex vagal response by itself.

Why is "Give IV adrenaline" not the answer?

Adrenaline is not needed unless the bradycardia persists with circulatory failure.

What concept does this question test?

It tests Special anaesthesia: oculocardiac reflex in Anaesthesia. Releasing the traction usually restores the rate, and IV atropine is given if the bradycardia persists or recurs. Adequate depth of anaesthesia and prophylactic anticholinergics can reduce the reflex.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Special anaesthesia: oculocardiac reflex?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.