title: Effect of different anesthetic agents on oculocardiac reflex in pediatric strabismus surgery.
abstract: OBJECTIVE
  The oculocardiac reflex (OCR) occurs frequently during pediatric strabismus surgery. The aim of this study was to assess the effects of various anesthetic regimens on the incidence of OCR during the surgery.
  
  
  METHODS
  Two hundred and eighty children, 1 to 9 years old, undergoing elective strabismus surgery, were randomly assigned to eight groups; ketamine-sevoflurane (KS), ketamine-desflurane (KD), ketamine-propofol (KP), ketamine-remifentanil (KR), midazolam-sevoflurane (MS), midazolam-desflurane (MD), midazolam-propofol (MP), and midazolam-remifentanil (MR). No premedication was given. Anesthesia was induced using ketamine 1 mg kg(-1) or midazolam 0.15 mg kg(-1) with 66% N(2)O in O(2). Laryngeal mask airways (LMAs) were placed with rocuronium 0.5 mg kg(-1). Anesthesia was maintained with sevoflurane 2-3 vol. %, desflurane 5-6 vol. %, propofol 7-8 mg kg(-1) h(-1), or remifentanil 0.75 microg kg(-1) over 1 min, followed by a continuous infusion of remifentanil 0.5 microg kg(-1) min(-1) with 66% N(2)O in O(2). Heart rate (HR) was recorded during extraocular muscle (EOM) manipulation. OCR was defined as a reduction in HR of more than 20% induced by the traction of an EOM.
  
  
  RESULTS
  In patients given ketamine, OCR occurred more frequently in the KP (65.7%) and KR (62.9%) groups than in the KD (29.4%) and KS (37.1%) groups (P < 0.05). In patients given midazolam, OCR occurred more frequently in the MP (54.3%) and MR (60.6%) groups than in the MD (36.4%) and MS (31.4%) groups (P < 0.05).
  
  
  CONCLUSIONS
  Propofol or remifentanil anesthesia was associated with a higher incidence of OCR during pediatric strabismus surgery than sevoflurane and desflurane anesthesia, when either ketamine or midazolam was used as an induction agent.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Seo-gu, Busan, Korea.
authors.forename: So Ron
authors.initials: SR
authors.lastname: Choi
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.forename: Jong Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung Cheol
authors.initials: SC
authors.lastname: Lee
authors.forename: Chan Jong
authors.initials: CJ
authors.lastname: Chung
mesh_terms: D000732:Androstanols; D000758:Anesthesia; D000768:Anesthesia, General / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects*; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D000077335:Desflurane; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology*; D007530:Isoflurane / Q000031:analogs & derivatives; D007649:Ketamine; D008297:Male; D008738:Methyl Ethers; D008874:Midazolam; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D013508:Ophthalmologic Surgical Procedures; D012024:Reflex, Oculocardiac / Q000187:drug effects*; D000077123:Rocuronium; D000077149:Sevoflurane; D013285:Strabismus / Q000601:surgery*
chemical_list: D000732:Androstanols; D000777:Anesthetics; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D007649:Ketamine; D000077335:Desflurane; D007530:Isoflurane; D008874:Midazolam; D000077123:Rocuronium