Korean J Anesthesiol.  2013 Jun;64(6):500-504. 10.4097/kjae.2013.64.6.500.

Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery

• Oh JN
• Lee SY
• Lee JH
• Choi SR
• Chin YJ

• KMID: 1767432
• DOI: http://doi.org/10.4097/kjae.2013.64.6.500

Abstract

BACKGROUND
The oculocardiac reflex (OCR) can be elicited during manipulation of the orbital structures in the strabismus correction surgery. A sinus bradycardia is the most common manifestation of OCR; and cardiac dysrhythmia and asystole may also occur. Various efforts to reduce OCR have been attempted, but without coherent outcome results.
METHODS
Sixty one children, undergoing elective strabismus surgery, were randomly allocated into 2 groups: Group K received ketamine 1.0 mg/kg; and Group M received midazolam 0.15 mg/kg for induction of anesthesia. Anesthesia was maintained with 1-1.3 MAC of sevoflurane with 50% N2O in O2. Heart rate and blood pressure were measured 30 seconds before extraocular muscle (EOM) traction and immediately after traction. The OCR was defined as a decrease in heart rate more than 20% of the baseline heart rate, following manipulating EOM. Postoperative nausea and vomiting (PONV) and emergence agitation (EA) were assessed in postanesthetic care unit (PACU).
RESULTS
Blood pressure before tightening EOM in Group K was higher than that in Group M (P < 0.05). However Delta HR (2.7 +/- 15% vs. - 0.9 +/- 16%) and incidence of OCR (10.0% vs. 19.4%) after traction an EOM were not different between the two groups. The occurrence of PONV (6.7 vs. 9.7%) and EA (30.0% vs. 22.6%) were similar.
CONCLUSIONS
Ketamine does not reduce the incidence of OCR compared with midazolam in pediatric strabismus surgery. In addition, ketamine does not increase the incidence of PONV and EA. In conclusion, it is reliable to use ketamine in pediatric strabismus surgery.

Keyword

General anesthesia; Ketamine; Midazolam; Oculocardiac reflex

MeSH Terms

Anesthesia
Anesthesia, General
Arrhythmias, Cardiac
Blood Pressure
Bradycardia
Child
Dihydroergotamine
Heart Arrest
Heart Rate
Humans
Incidence
Ketamine
Methyl Ethers
Midazolam
Muscles
Orbit
Postoperative Nausea and Vomiting
Reflex, Oculocardiac
Strabismus
Traction
Dihydroergotamine
Ketamine
Methyl Ethers
Midazolam