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

Ji Na Oh, Seung Yoon Lee, Ji Hyeon Lee, So Ron Choi, Young Jhoon Chin, Ji Na Oh, Seung Yoon Lee, Ji Hyeon Lee, So Ron Choi, Young Jhoon Chin

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 Δ 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.

Keywords: General anesthesia; Ketamine; Midazolam; Oculocardiac reflex.

References

    1. Donlon JV, Doyle DJ, Feldman MA. Anesthesia for eye, ear, nose, and throat surgery. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller's anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2009. pp. 2378–2384.
    1. McGoldrick KE, Gayer SI. Anesthesia for ophthalmologic surgery. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical anesthesia. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. pp. 1327–1338.
    1. Rodgers A, Cox RG. Anesthetic management for pediatric strabismus surgery: Continuing professional development. Can J Anaesth. 2010;57:602–617.
    1. Dell R, Williams B. Anaesthesia for strabismus surgery: a regional survey. Br J Anaesth. 1999;82:761–763.
    1. Hahnenkamp K, Hönemann CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr Anaesth. 2000;10:601–608.
    1. Fayon M, Gauthier M, Blanc VF, Ahronheim GA, Michaud J. Intraoperative cardiac arrest due to the oculocardiac reflex and subsequent death in a child with occult Epstein-Barr virus myocarditis. Anesthesiology. 1995;83:622–624.
    1. Blanc VF. Atropine and succinylcholine: beliefs and controversies in paediatric anaesthesia. Can J Anaesth. 1995;42:1–7.
    1. Misurya VK, Singh SP, Kulshrestha VK. Prevention of oculocardiac reflex (O.C.R) during extraocular muscle surgery. Indian J Ophthalmol. 1990;38:85–87.
    1. Gupta N, Kumar R, Kumar S, Sehgal R, Sharma KR. A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery. Anaesthesia. 2007;62:1110–1113.
    1. Braun U, Feise J, Mühlendyck H. Is there a cholinergic and an adrenergic phase of the oculocardiac reflex during strabismus surgery? Acta Anaesthesiol Scand. 1993;37:390–395.
    1. Zimmerman G, Steward DJ. Bradycardia delays the onset of action of intravenous atropine in infants. Anesthesiology. 1986;65:320–322.
    1. Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand. 2008;52:1273–1277.
    1. Allison CE, De Lange JJ, Koole FD, Zuurmond WW, Ros HH, van Schagen NT. A Comparison of the incidence of the oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children. Anesth Analg. 2000;90:306–310.
    1. Oh AY, Yun MJ, Kim HJ, Kim HS. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth. 2007;99:262–265.
    1. White PF, Way WL, Trevor AJ. Ketamine - its pharmacology and therapeutic uses. Anesthesiology. 1982;56:119–136.
    1. Choi SH, Lee SJ, Kim SH, Kim JH, Kwon HH, Shin YS, et al. Single bolus of intravenous ketamine for anesthetic induction decreases oculocardiac reflex in children undergoing strabismus surgery. Acta Anaesthesiol Scand. 2007;51:759–762.
    1. Choi SR, Park SW, Lee JH, Lee SC, Chung CJ. Effect of different anesthetic agents on oculocardiac reflex in pediatric strabismus surgery. J Anesth. 2009;23:489–493.
    1. Watcha MF, Simeon RM, White PF, Stevens JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatient. Anesthesiology. 1991;75:204–209.
    1. Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997;87:1298–1300.
    1. Gayer S, Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am. 2006;19:269–278.
    1. Kovac AL. Management of postoperative nausea and vomiting in children. Paediatr Drugs. 2007;9:47–69.
    1. Saarnivaara L. Comparison of thiopentone, Althesin, and ketamine in anaesthesia for otolaryngological surgery in children. Br J Anaesth. 1977;49:363–370.

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