Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial
Fatma Ferda Kartufan, Nurcan Kizilcik, Sule Ziylan, Ferdi Menda, Fatma Ferda Kartufan, Nurcan Kizilcik, Sule Ziylan, Ferdi Menda
Abstract
Objective: In this single-blind, observational prospective clinical trial, we aimed to determine and compare the effects of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of oculocardiac reflex (OCR).
Methods: Forty-five patients were divided into three groups. Group M received 0.5 mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1 mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR, and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups.
Results: The mean HR1, HR2, and HR3 values were significantly increased (p=0.002, p < 0.001, p < 0.001) and the incidence of OCR (p=0.004) was significantly decreased in Group H and in Group HM (for all, p < 0.01) compared to Group M. The most common orbital muscle in which OCR occurred was the rectus medialis.
Conclusion: Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to premedication with midazolam alone. This study was registered on https://ichgcp.net/clinical-trials-registry/NCT03806270" title="See in ClinicalTrials.gov">NCT03806270.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Copyright © 2022 Fatma Ferda Kartufan et al.
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References
- Garcia C. A. D. A., Sousa A. B. D., Mendonça M. B. D. M., Andrade L. L. D., Oréfice F. Prevalence of strabismus among students in Natal/RN-Brazil. Arquivos Brasileiros de Oftalmologia . 2004;67(5):791–794. doi: 10.1590/s0004-27492004000500018.
- Chia A., Dirani M., Chan Y. H., et al. Prevalence of amblyopia and strabismus in young Singaporean Chinese children. Investigative Ophthalmology & Visual Science . 2010;51(7):3411–3417. doi: 10.1167/iovs.09-4461.
- Jackson S., Harrad R. A., Morris M., Rumsey N. The psychosocial benefits of corrective surgery for adults with strabismus. British Journal of Ophthalmology . 2006;90(7):883–888. doi: 10.1136/bjo.2005.089516.
- Agaje B. G., Delelegne D., Abera E., et al. Strabismus prevalence and associated factors among pediatric patients in southern Ethiopia: a cross-sectional study. Journal of International Medical Research . 2020;48(10) doi: 10.1177/0300060520964339.030006052096433
- Wan X., Wan L., Jiang M., Ding Y., Wang Y., Zhang J. A retrospective survey of strabismus surgery in a tertiary eye center in northern China, 2014-2019. BMC Ophthalmology . 2021;21(1):p. 40. doi: 10.1186/s12886-021-01805-w.
- Dunville L. M., Sood G., Kramer J. StatPearls . Treasure Island, FL, USA: StatPearls Publishing; 2020. Oculocardiac Reflex.
- Donlon J. V., Doyle D. J., Feldman M. A. Anesthesia for eye, ear, nose and throat surgery. In: Miller R. D., editor. Miller’s Anesthesia . Philadelphia, PA, USA: Churchill Livingstone; 2006. pp. 2527–2555.
- Neils D. M., Singanallur P. S., Vasilakis M., Wang H., Tsung A. J., Klopfenstein J. D. Incidence and ramifications of the oculocardiac reflex during the orbitozygomatic approach: a prospective assessment. World Neurosurgery . 2014;82(6):e765–e769. doi: 10.1016/j.wneu.2013.08.032.
- Aydın B. G., Küçükosman G., Pişkin Ö, et al. Factors affecting oculocardiac reflex incidence in pediatric strabismus surgery: retrospective study. JARSS . 2021;29(1):58–64. doi: 10.5222/jarss.2021.29484.
- Choi S. R., Park S. W., Lee J. H., Lee S. C., Chung C. J. Effect of different anesthetic agents on oculocardiac reflex in pediatric strabismus surgery. Journal of Anesthesia . 2009;23(4):489–493. doi: 10.1007/s00540-009-0801-0.
- Arnold R. W., Jansen S., Seelig J. C., Glasionov M., Biggs R. E., Beerle B. Anesthetic impacts on the oculocardiac reflex: evidence from a large, observational study. Clinical Ophthalmology . 2021;15:973–981. doi: 10.2147/opth.s300860.
- Oh A., Yun M., Kim H., Kim H. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. British Journal of Anaesthesia . 2007;99(2):262–265. doi: 10.1093/bja/aem145.
- Gilani S. M., Jamil M., Akbar F., Jehangir R. Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery. Journal of Ayub Medical College, Abbottabad . 2005;17(4):57–59.
- Çeliker V., Dal D., Saricaoglu F., Başgül E., Aypar Ü. Comparison of the effects of midazolam and sevoflurane on oculocardiac reflex. Türk Anesteziyoloji ve Reanimasyon Dernegi Dergisi . 2004;32:367–372.
- Ha S. G., Huh J., Lee B. R., Kim S. H. Surgical factors affecting oculocardiac reflex during strabismus surgery. BMC Ophthalmology . 2018;18(1):p. 103. doi: 10.1186/s12886-018-0771-9.
- Watcha M. F., Simeon R. M., White P. F., Stevens J. L. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients. Anesthesiology . 1991;75(2):204–209. doi: 10.1097/00000542-199108000-00006.
- Deriy L., Gerstein N. S., Panikkath P., Ram H., Starr B. Essentials of Cardiac Anesthesia for Noncardiac Surgery . Henderson, NV, USA: Thoracic Key; 2019. Cardiac patients requiring emergent noncardiac surgery; pp. 404–452.
- Shakil H., Wang A. P., Horth D. A., Nair S. S., Reddy K. K. V. Trigeminocardiac reflex: case report and literature review of intraoperative asystole in response to manipulation of the temporalis muscle. World Neurosurgery . 2019;122:424–427. doi: 10.1016/j.wneu.2018.10.186.
- Başağaoğlu B., Steinberg A., Tung I. T., Olorunnipa S., Maricevich R. S. Oculocardiac reflex as a late presentation of orbital floor fracture. Journal of Craniofacial Surgery . 2018;29(7):e720–e722. doi: 10.1097/scs.0000000000004966.
- Rahimi Varposhti M., Moradi Farsani D., Ghadimi K., Asadi M. Reduction of oculocardiac reflex with Tetracaine eye drop in strabismus surgery. Strabismus . 2019;27(1):1–5. doi: 10.1080/09273972.2018.1561732.
- Ducloyer J. B., Couret C., Magne C., et al. Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery. European Journal of Ophthalmology . 2019;29(6):606–614. doi: 10.1177/1120672118804798.
- Gayer S., Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am . 2006;19(2):269–278. doi: 10.1016/j.ohc.2006.02.012.
- Misurya V. K., Singh S. P., Kulshrestha V. K. Prevention of oculocardiac reflex (O.C.R) during extraocular muscle surgery. Indian Journal of Ophthalmology . 1990;38(2):85–87.
- Hahnenkamp K., Hã–nemann C. W., Fischer L. G., Durieux M. E., Muehlendyck H., Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Pediatric Anesthesia . 2000;10(6):601–608. doi: 10.1111/j.1460-9592.2000.00588.x.
- White P. F., Way W. L., Trevor A. J. Ketamine its pharmacology and therapeutic uses. Anesthesiology . 1982;56(2):119–136. doi: 10.1097/00000542-198202000-00007.
- Abdelaziz H. M. M., Bakr R. H., Kasem A. A. Effect of intranasal dexmedetomidine or intranasal midazolam on prevention of emergence agitation in pediatric strabismus surgery: a randomized controlled study. Egyptian Journal of Anaesthesia . 2016;32(3):285–291. doi: 10.1016/j.egja.2015.11.009.
- Joo J., Lee S., Lee Y. Emergence delirium is related to the invasiveness of strabismus surgery in preschool-age children. Journal of International Medical Research . 2014;42(6):1311–1322. doi: 10.1177/0300060514549783.
- Rodgers A., Cox R. G. Anesthetic management for pediatric strabismus surgery: continuing professional development. Canadian Journal of Anesthesia/Journal canadien d’anesthésie . 2010;57(6):602–617. doi: 10.1007/s12630-010-9300-x.
- Guaiana G., Barbui C., Cipriani A. Hydroxyzine for generalised anxiety disorder. Cochrane Database of Systematic Reviews . 2010;12 doi: 10.1002/14651858.CD006815.pub2.CD006815
- Bethesda (MD) LiverTox: Clinical and Research Information on Drug-Induced Liver Injury . Bethesda, MD, USA: National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
- .
Source: PubMed